Online Benefits Administration Guide

Transcription

1 Online Benefits Administration Guide Humana.com GCHJ6UJEN 0315

2 Welcome to Online Benefits Administration Online Administration of your company s benefits will enable you to put the internet to work and allow you to manage changes more quickly and efficiently. You re managing your benefits in real time. If an employee leaves the company today, you can terminate their benefits today. If you hire someone and benefits go into effect immediately, you can add them as a new hire today and they will be enrolled in 24 to 48 hours. Imagine the time that you will save at the end of the month when you re reconciling your bill. You won t have to track odd credits and debits for several months. One person will be set up as the primary contact for the employer portal and that person can assign user rights to multiple users for specific sections of the website. For example, if you want someone from Accounts Payable to have access to the Billing & Payments section but not the Enrollment Maintenance, you can set it up that way. And speaking of billing & payments, you can pay your bill online and you have the option of entering several accounts that you can choose to pay the bill from. Let s get started! Have available: Group number Organization s ZIP code Primary contact s mother s maiden name Register your group online at Humana.com. See more registration information on page 5. If you need any assistance, please call the Employer Web Team at

3 Index: Contact us... 3 Primary Access Administrator (PAA)... 5 Registration... 5 Adding additional users... 6 Setting up bank accounts... 8 Electronic funds transfer... 9 Common issues and how to resolve Add a new hire Move an employee to a different benefit offering Changing employee s benefits Terminate an employee s coverage Add, edit or terminate dependents coverage View a member s Benefit Plan Document ID cards and Proof of Coverage Employee and utilization reports Additional benefit reports How to send and retrieve secure Explanation of terms Eligibility waiting periods Relationship codes Frequent events & materials needed Browsers and encryption

4 Contact us Employer Web Team (EWT) a.m. - 6 p.m. Eastern time Employer Concierge Team (ECT) employerconciergeteam@ humana.com WHO CONTACTS Benefits Administrator Benefits Administrator HOW WE CAN HELP -Help with registration -Online enrollment -Web functionality issues - Member issues addressed by B.A. - Anything related to the group that is not Web related Open Enrollment Hotline Employee - Every group does not have Hotline access. MyHumana questions Employee -Reset passwords - Answer questions regarding the employee s benefits, deductibles, finding in network physicians, etc. -Navigation through MyHumana The secured employers section of Humana.com is called the Employer Self Service Center. It makes administering your Humana plan easier. Once registered on our website, access is granted for the following resources: What s New? Communication Center Enrollment Maintenance Billing Administrative Guides & Tools Search Tools Reporting Website Security Administration Additional Savings Find out about the latest enhancements to the Employer Self Service Center Exchange private, secure with Humana Complete many of your daily enrollment maintenance tasks, including adding new employees, changing coverage and terminating an employee s benefits View your monthly statement, make a premium payment Explore features that can simplify plan administration such as links to eligibility information Use employer search tools and get answers to frequently asked questions Create, view, and print a variety of online reports, including an employee roster and eligibility reports Grant Web access rights to qualified personnel and maintain Web security information for individuals or for your entire organization Find out about discounts like Humana s Life Style Discount Program humana.com/insurance-through-employer-support/benefits/group-health-resources/lifestyle-discounts discount program 4

5 Overview Primary Access Administrator (PAA) The PAA is the point of contact for web access for the organization. This person performs day-to-day functions and can assign access for others in the organization. The PAA will log in to the Employer Self Service Center to register new users and perform administrative tasks. An unlimited number of users can be added. Have this information available before you register at Humana.com. Group number Organization s ZIP code Primary contact s mother s maiden name If you have questions or need help, please call Step 1: Register Log into Humana.com Choose Register now Provide Validating Information This information can be obtained from the plan documents or your Humana Sales Executive. 5

6 Step 3: Read & Agree to the Online Services Agreement and Web Confidentiality Agreement The person in agreement must be legally authorized to sign contracts on behalf of the organization. Step 3: Create username and password Step 4: Registration complete Click on the green tab to go into the Employer Self-Service Dashboard to access the employer portal. Click on add user to grant additional users access to your employer account. Adding additional users From the Employer Self-Service dashboard, click on My Company tab Select Security Administration Select Register New User for Security Access Create a user ID & AKA (Also Known As) name. Please note that user ID and AKA cannot be the same Complete all required fields (Name, phone number, address, etc.) 6

7 Once you select NEXT A confirmation page will be generated and ask you to write down the user ID, AKA name, and a system generated temporary ID. IMPORTANT: You will not see this information again, and it CANNOT be retrieved. Please note this information to provide to the secondary user. Click NEXT again and you will be brought to a file folder. Click on the file folder Humana_Employer. Options for various business functions will display. Select the functions of the website for which you are granting access. Start with granting ALL users access to the two areas highlighted. Assigning access to billing information If you selected Billing as a business function on the previous screen, then you will need to select the associated employer number in this screen. Explanation: Which employer group numbers and associated billing profiles should the user should have access to in order to perform Billing functions? Click SAVE and then OK to return to Employer Self Service Center Provide the user ID and temporary password to the secondary user In this example, Nikki has access to perform Billing Functions for all three of the Employer ID s in her company. 7

8 Financials Timely eligibility changes are the responsibility of the Employer so our suggested best practice is to submit changes as they occur. Online submissions are typically processed within 24 to 48 hours, so any changes and/or credits will most likely be reflected on the next premium statement. Payments submitted BEFORE 7 p.m. Eastern time are credited to your account the SAME day. Payments submitted AFTER 7 p.m. Eastern time are credited to your account the NEXT day. Bank accounts and payment options Set up the accounts from which the premium will be paid Click the Go to Billing button For first time users, you will be prompted to set up a bank account. Enter a Nickname for the Account Enter the name of the Account Holder (could be business name). Enter the Routing/Transit Number Enter the Account Number Indicate the Type of Account checking or savings Click on Enroll This Bank Account Humana will verify the account information and once that is completed, the account can be used to make immediate electronic payments. Make a one-time payment or set up for recurring payments. 8

9 Information on e-billing View your monthly statement Select the Billing tab Select View Your Bill Choose the organization to view, group number, and billing month Click on the link that says PDF Statement to view a copy of the bill Note: Adobe Acrobat Reader is required to open the documents. Set up an electronic funds transfer Select the Billing tab Choose Make a Bill Payment Indicate which checking or savings account will be used to pay the invoice Enter the payment amount Confirm your payment information on the Verification screen and click OK if the information is correct 9

10 Managing employee benefits Common issues and how to resolve Once an employee s benefits are terminated, their information remains in the system for up to 18 months Members can see their own information, deductibles and usage through their own ID and login When entering member ID, members do not need to add the suffix - For example, if the ID is , the -05 isn t necessary for log in Only one enrollment event can be submitted per member per 24 hour period Terms you ll want to know Subscriber - Member or participant directly eligible for employer benefits due to employment Dependent - Family or domestic partner eligible for employer benefits Add an Employee for benefit Tips: Most information can be obtained from an employment application. If you re adding dependents for the new hire, the following information is required: First and last name Date of birth Address Currently, the dependent s Social Security number (SSN) is not a required field but will have to be entered at some point, so you may want to make arrangements to follow up for dependents. To add coverage for an employee, just follow these steps. Click on Next, Continue, or Submit as needed to go to the next page. Changes entered through the Enrollment Center are updated in Humana s systems within a hour period 1. Select the Manage Employees link on the Employer Self-Service Center home page 2. Click the Add an Employee link Note: All employee administration takes place in this tab. 10

11 All line items with a red asterisk (*) are mandatory fields for submission. Use the drop-down box to choose which eligibility group to which the subscriber belongs. Date of hire and date of submission may differ. After selecting Next, you will be asked to add the reason for adding coverage. Select the most appropriate reason for adding coverage, enter the effective date, and the date you are submitting the event online. Adding dependents For each dependent you need to add, click Add Dependent and complete the fields noted by an asterisk. Once you have added all dependents, click Next and that will take you to the coverage screen. On the next coverage screen, for each benefit option available, use the Select Plan drop-down box to select the employee s benefits For each benefit option available, make sure there s a check mark next to the name of each dependent to be covered Answer the questions about prior coverage and other coverage and complete the detail screens if necessary Once all benefits have been selected, Confirm the entire enrollment and click Submit Select Print Page on the confirmation screen if you want a copy for your records If you need to make additional changes, go to the top of the page and click on Home to return to the Enrollment Center main menu 11

12 Modifying coverage Modify coverage for an existing employee To modify the employee s coverage - for instance, they were recently married, had a child, or gained coverage from moving from part time to full time. - simply follow these steps. Click on Next, Continue, or Submit as needed to go to the next page: Click the Modify an Employee link When our online enrollment and maintenance site appears, click on Modify Subscriber/ Dependent Info and/or Coverage Enter the employee s Social Security number or last name, then select Search to find the employee in the system Choose the most appropriate reason or event for a coverage change from the drop-down box Enter the effective date for coverage and the date you re submitting the form online Verify the employee s demographic information and make any necessary changes For each benefit option available, use the Select Plan drop-down box to select the employee s benefits For each benefit option available, make sure there s a check mark next to the name of each dependent to be covered Answer the questions about prior coverage and other coverage and complete the detail screens if necessary Confirm the entire enrollment and click Submit 12

13 Terminate an employee's coverage To terminate coverage for an employee and his or her dependents, just follow these steps. Click on "Next," "Continue," or "Submit" as needed to go to the next page: Click the Modify an Employee link Click the Terminate an Employee link When our online enrollment and maintenance site appears, click on Terminate a Subscriber Enter the employee s Social Security number or last name, then select Search to find the employee whose coverage will be terminated Choose the reason for termination from the drop-down box Enter the coverage termination date (the last day that the employee will be covered until midnight, based on the group s provisions - e.g., last day of the month, last day worked) and the loss of eligibility date (the actual last day the employee worked) Indicate whether you d like to enroll the subscriber in COBRA or State Continuation after the termination - use the COBRA option only if your group hasn t elected to use Ceridian Verify the employee s termination information, make any necessary changes, and click on Submit Employees who have questions regarding individual insurance plans can call HumanaOne at Find details about COBRA, including eligibility and legislation that may affect their coverage or rates Get quotes for HumanaOne individual plans Compare rate differences between COBRA and HumanaOne Find answers to frequently asked questions regarding continuation of coverage Add, edit or terminate depdendent s coverage Before you begin, have available: Employee Social Security Number (SSN) Reason for Coverage Change Effective Date of Coverage Note the Date Submitted 13

14 Add a dependent to an existing employee To add dependent coverage for an existing employee, just follow these steps. Click Next, Continue, or Submit as needed to go to the next page: Select the Manage Employees tab on the home page of your Employer Dashboard. Then click the link that says Modify an Employee. Enter the employee s Social Security number or last name, then select Search to find the subscriber who is adding a dependent. Choose the reason for a coverage change from the drop-down box - for instance, birth or marriage. Enter the effective date for coverage and the date you re submitting the form online. Verify the employee s demographic information and make any necessary changes. For each dependent you need to add, click on Add Dependent and complete the fields noted by a red dot. For each benefit option available, use the Select Plan drop-down box to select the employee s benefits. For each benefit option available, make sure there s a check mark next to the name of each dependent to be covered. Answer the questions about prior coverage and other coverage and complete the detail screens if necessary. Confirm the entire enrollment and click Submit. 14

15 Modify or terminate existing dependent coverage To modify or terminate dependent coverage, but still keep coverage for the employee, just follow these steps. Click on Next, Continue, or Submit as needed to go to the next page: From the Employer Dashboard, click the tab that says Manage Employees and then select the link that says Modify an Employee. This will launch our online enrollment center - HRBA. Enter the employee s Social Security number or last name, then select Search to find the subscriber who is terminating a dependent s coverage. Choose the reason for a coverage change from the drop-down box. Examples include divorce, gain/loss of other coverage, or terminate dependent. Please note, a terminate dependent event should only be used if the dependent will never be covered under your employees plan with your group again. This will delete the history entirely. Examples of when to use this event are if they are an overage dependent or deceased. Enter the effective date for the coverage change and the date you re submitting the form online. Verify the employee s demographic information and make any necessary changes. Make sure the name of the dependent you wish to remove from coverage is on the list of dependents. Click on the check mark next to the dependent s name to deselect them - removing the check mark means the dependent won t be included in coverage. Confirm the information you entered and click Submit. 15

16 Plan documents, ID cards, Proof of Coverage and reports View a member s Benefit Plan Document From the My Company link on the home page: Select the tab that says My Company Click on Plan Details Select the group plan you wish to view (if applicable) Select Summary of benefits and coverage link next to Medical plan Enter the group number to be viewed and click on Find Coverage If Certificates and group policies are available, they ll appear next to the product description and plan year information referenced above Many of the documents in the Employer Self-Service Center are PDFs (Portable Document Format). You must have Adobe Acrobat 4.0 or higher to view and print Humana forms. ID cards and Proof of Coverage 1. Select Manage Employees tab 2. Click on View and Print ID cards or View and Print Proof of Coverage 16

17 WHAT YOU WANT Vision and Dental ID cards Proof of Coverage Order replacement Medical ID card WHERE TO GO View and Print Proof of Coverage View and Print Proof of Coverage View and Print Proof of Coverage A new card will be mailed to the employee s home address within 10 business days. View Medical ID cards View and Print ID Cards Note: ID cards are not viewable until 7-10 days after an enrollment change was submitted. Employee and utilization reports Depending on the benefits your organization offers, the following reports may be available under the Reports tab on the home page: Enrollment and Benefit reporting through HRBA reports Census Files View HumanaVitality reporting View claims information** Only available for ASO groups Additional benefit reports Depending upon the benefits offered in your organization, you can access additional reporting separate from the utilization reports. These reports may include: Flexible spending account reports View health savings account reports Personal care account reports Full-time student verification status reports eplancompass Reports (note that eplan Compass Reports are not available to all groups) 17

18 How to send and retrieve secure messages This feature in the Employer Self-Service Center allows you to send and receive secure messages while adhering to HIPPA regulations. To send a secure message For instance, if you need to send private information about a member, click on the small green envelope on the right side of the home page. Inbox screen will appear automatically. To read a message, just click on the blue subject line. To send a message, click on the Compose Mail link on the right side of the home page. The Compose screen will appear. Enter a subject line, type the body of your message, add any attachments, and click on Send. If you have e-access to an inbox for more than one group, use the Select a Message Box drop-down menu at the top of the page to choose the message center for a particular group. The drop-down menu displays all registered groups you can access. Click on the tab for Information Center choose For You Choose your action -the yellow highlighted area To retrieve messages from Humana Enter this address in your browser: Click on the second bullet to start the registration process Enter first and last name, address Click Submit Check your and use the links within to activate the secure process. 18

19 Next, you will also receive a Welcome and it will advise you to follow a link to set up a Secure Mail password and a password hint by clicking on View Message. Once you set up a password and a hint- you will have access to the Secure Mail system. Any time you receive a Secure Message from Humana, log in through the link provide in the or by going to Additional resources Explanation of terms Adoption/Legal Guardianship Birth Change in Eligibility Group Change prior/other coverage Child Eligible Disable Child Newly Eligible Student Court Ordered Coverage Coverage Termination Add a child due to adoption or the child has been placed with the subscriber under legal guardianship. If submitting an online enrollment for this reason, please fax legal documentation to our enrollment department at Add newborn coverage * Upon delivery, the employee can call to ensure coverage. Additions must take place within 30 days of birth. The BA can also add the newborn, or specific details on the infant via HRBA. If details are not updated within 30 days of the birth, please call for assistance. Move the subscriber from on eligibility group to another. Update subscriber s/member s prior other coverage information. Add a dependent that has been declared disabled. Current dependent newly enrolled as a full time student. Add dependent due to court order. If submitting an online enrollment for this reason, please fax legal documentation to our enrollment department at The Coverage Termination date is the last date the employee is covered. This will depend on the group s provisions; it could be the last day of the month, or the date of termination. 19

20 Divorce/Legal separation Gain/Loss other Coverage HSA Start/Change Contribution Late Enrollee Loss of Eligibility Marriage Move out of Service Area New Hire Open Enrollment Rehire Pre-Enrollment Remove a spouse from subscriber s plan due to divorce or legal separation. If submitting an online enrollment for this reason, please fax legal documentation to our enrollment department at Multiple reasons Examples: The subscribers spouse has coverage through her employer, and that coverage ends. The spouse would now be eligible for coverage under the subscriber s policy. Going from part time to full time or vice versus would also be considered a gain/loss event. Change to employee s HSA contribution. The subscriber is enrolling outside of the open enrollment. Loss of Eligibility relates to the date when an individual member is no longer eligible for benefits. This date can occur any day of the month such as a birthday or wedding day but the member s termination is actually effective on the Coverage Termination date. Add a new spouse to the existing subscribers coverage. If submitting an online enrollment for this reason, please fax legal documentation to our enrollment department at A subscriber or member has moved out of service area. Add a person newly hired at the company. The period of time when the employees choose benefits for the new plan year. Add rehired subscribers demographic/coverage election. Once this is complete, the member would be allowed to complete their own enrollment in MyHumana. ***Only available for some groups*** ELIGIBILITY WAITING PERIODS If Hire Date is 6/24 & Benefits Eligibility is immediately after. If Hire Date is 6/24 & Benefits Eligibility is the FIRST day of the month FOLLOWING...30 days 7/24 30 days 8/1 60 days 8/23 60 days 9/1 90 days 9/22 90 days 10/1 Relationship codes Relationship codes 0 = Subscriber 1= Children 3= Spouse 20

21 Frequent events & materials needed Any corrections due to system functionality require a call to the Employer Web Team SSN Correction The BA will need to send in a copy of the change form with the correct SSN or a copy of the subscriber Social Security card. The correction will need to be made in the platform first; the web specialist sends Enrollment a ticket to have the incorrect SSN corrected. Then, the web team will correct the web. Effective Date Correction Date of Hire Correction Duplicated Subscriber or dependent Changing the Eligibility Group Call the web team and they will assist the group in submitting another event, or by correcting the dates with enrollment if this can t be corrected during the call Call the web team and provide the correct date of hire. They will send a request to enrollment to correct the date of hire, and then correct the web. The BA will need to call a web specialist to have a duplicate subscriber or dependent deleted from the web due to system reasons. The web specialist will send an IT request to get the duplicate person removed. Possible reasons a BA would call in regarding the group eligibility: If a member is terminated and the group is going through OE and the eligibility group changes, then the BA would need to change the eligibility group first before the subscriber can be enrolled on the correct plan. If the BA does not see the correct Benefit listed under the Coverage Level drop down box, then the BA needs to change the Eligibility group to get the correct benefit that is tied to it. Primary Care Physician Change/ Updates If the BA enrolls the subscriber online for coverage and puts a dummy PCP (9999) number due to the subscriber not having listed a PCP, then the BA can go back and correct/change the PCP within the event (that was created) to enroll the subscriber. How to correct a PCP within the open event: 1. The BA will need to select Modify Subscriber/ Dependent info 2. Check the box next to the open event and then hit select and continue 3. Keep hitting next until you get to the PCP screen 4. Check the box to enter new PCP# and put the correct PCP# and continue to review and finish Newborns The BA will need to check View Subscriber Summary View Dependent history to see if the newborn has been added for first 30 days coverage If the newborn is already showing coverage for first 30 days the BA should: 1. Modify Subscriber/ Dependent Info 2. Create the event Gain/Loss of Other Coverage and make the effective date the day after the termination date listed on the Dependent History screen. 3. Only make a change to the dependent demographic screen if the newborn name is listed as boy/girl, or if there is an end date for coverage on the Dependent History screen. 4. The BA will need to select coverage for the newborn on the Coverage screen 5. Then continue onto the Review and Finish screen and Submit 21

22 Retro Termination Date Correction COBRA IMPORTANT: The BA will need to call a web specialist to correct a retro termination date on the web because the group billing invoice will be affected If the termination is more than 60 days in the past, the groups billing rep will need to be contacted for approval. The Billing Representative then makes the retro termination in the system and that term date should roll back to the web If the BA already submitted the termination event for the employee, go to Modify Employee and the option to add COBRA will be available. If the BA has not terminated coverage, then the BA will select Terminate subscriber Enter the effective Date and click Continue Select Launch COBRA/ Continuation Event for the subscriber after termination Then, all the BA has to do is follow through with the Cobra enrollment Lost password recovery Here s how to regain access to the Employer Self-Service Center if you forget your password: 1. From Humana.com, click the link that says Forgot your password? Then you will select Select a user type link under Other Registered User. Select that you are an Employer and then follow the prompts to reset your password. 2. If you need further assistance, call the Employer Web Team at

23 Browsers and encryption To protect the privacy of our customers and members, Humana uses the most current, top-level technology. We currently support the following browsers, which can maintain a high level of security: Internet Explorer 5.5, 6.x, and 7.x Netscape 6.x Browser security is closely linked to encryption code. For that reason, users can only access the secure sections of Humana s site using a browser equipped with 128-bit encryption or higher - which means your Web activity is encrypted before it s transmitted over the Internet using 128- bit secure socket layer (SSL) encryption technology. This technology works in tandem with the built-in security features of Internet browsers such as Microsoft Internet Explorer or Netscape Navigator. This technology is the most secure form of encryption widely used on the Internet today. Humana.com Humana medical plans are offered by Humana Medical Plan, Inc., Humana Employers Health Plan of Georgia, Inc., Humana Health Plan, Inc., Humana Health Benefit Plan of Louisiana, Inc., Humana Health Plan of Ohio, Inc., Humana Health Plans of Puerto Rico, Inc. License # , Humana Wisconsin Health Organization Insurance Corporation, or Humana Health Plan of Texas, Inc. - A Health Maintenance Organization, or insured by Humana Health Insurance Company of Florida, Inc., Humana Health Plan, Inc., Humana Health Benefit Plan of Louisiana, Inc., Humana Insurance Company, Humana Insurance Company of Kentucky, Humana Insurance of Puerto Rico, Inc. License # , or administered by Humana Insurance Company or Humana Health Plan, Inc. Statements in languages other than English contained in the advertisement do not necessarily reflect the exact contents of the policy written in English, because of possible linguistic differences. In the event of a dispute, the policy as written in English is considered the controlling authority. For Arizona Residents: Offered by Humana Health Plan, Inc. or insured by Humana Insurance Company. Administered by Humana Insurance Company. Please refer to your Benefit Plan Document (Certificate of Coverage/Insurance or Summary Plan Description) for more information on the company providing your benefits. Humana group dental plans are offered by Humana Insurance Company, HumanaDental Insurance Company, Humana Insurance Company of New York, The Dental Concern, Inc., Humana Medical Plan of Utah, CompBenefits Company, CompBenefits Insurance Company, CompBenefits Dental, Inc., CompBenefits of Alabama, Inc., Humana Employers Health Plan of Georgia, Inc. or DentiCare, Inc. (d/b/a CompBenefits) Humana group vision plans are offered by Humana Insurance Company, HumanaDental Insurance Company, Humana Health Benefit Plan of Louisiana, Humana Insurance Company of Kentucky, Humana Insurance Company of New York, CompBenefits Insurance Company, CompBenefits Company, or The Dental Concern, Inc. Humana life and supplemental plans are offered by Humana Insurance Company, Humana Insurance Company of Kentucky or Kanawha Insurance Company. Humana long term disability and short term disability plans are offered by Kanawha Insurance Company or Humana Insurance Company. Humana Workplace Voluntary Benefits are insured by Humana Insurance Company, Kanawha Insurance Company or Humana Insurance Company of New York. Our health benefit plans have exclusions and limitations and terms under which the coverage may be continued in force or discontinued. For costs and complete details of the coverage, call or write your Humana insurance agent. GCHJ6UJEN 0315