FREQUENTLY ASKED QUESTIONS ABOUT HIPPA

Is it the responsibility of the group to obtain and retain the Declination forms?

Yes, Declination forms must be collected and maintained by the group.

Can late enrollees enter the plan by filling out the Health Questionnaire?

Late enrollees may be required to wait until their group's next re-enrollment period before coverage becomes effective.

Are there special circumstances which enable the late enrollee to become covered earlier?

Yes, they are as follows:

The applicant was covered under another group plan and coverage under that plan ceased.

A court has ordered coverage for a dependent who is not enrolled.

No declination form is on file, explaining the possible consequences of declining coverage, (the employer may be responsible to Blue Cross for a failure to maintain a signed declination in a form approved by Blue Cross), and

There is a change in family status through marriage, birth, or adoption of a child.

Are former members sent HIPAA certification?

HIPAA certifications to former members by the 5th of the second month following termination. For example, certifications for June cancellations would be sent by August 5th.

How do I know if my business meets the basic qualification for group insurance:

You must have a minimum of 2 employees or owners to qualify for a group health plan.

These 2 people may be:

Employer and Employee

Two Partners

Two Officers of a Corporation.

If you have employees, you will need to provide a copy of your most recent DE-6 (State Quarterly Wage Report). This will be used to verify eligible employees. For partnerships or corporations, you will need a business license, articles of incorporation or other documents that can verify the legitimacy of your business and the participation of all people to be covered under the group health plan

What else should I know before I request a quote:

Minimum employer contribution must be at least 50% of the employee only premium. The employer is not required to contribute to the premium for dependents. Generally, 75% percent of all eligible employees must enroll under the group plan. Rates will vary based on the size of your group, age of employees, geographical location, overall healthiness of employees, as well as other factors. Many insurance companies offer a one-year rate guarantee on the monthly premium. Eligible employees are any employees that work 30 or more hours per week for the company. The employer may elect to include employees that work 20 or more hours per week. If an employee is already covered under another group health plan, they are not included in the 75% minimum eligibility factor. No employee may be denied coverage due to pre-existing conditions for qualifying group health plans. Most companies have options in which they allow employees to choose from a variety of plans. When you enroll in a new group health plan, you will need to decide the length of time that a new hire must be with your company before he/she can be added to the group health plan.

What if I change jobs?

Under Federal Law, you have the right to carry with your group health insurance coverage for 18 months. Under certain conditions, this may be extended to 29 or 36 months.

What if I become Unemployed?

The same rights apply if you become unemployed as you do if you change jobs. Forms must submitted within 60 days or coverage can be dined.