HBR TRAINING TPA Implementation. April 2018

Transcription

1 HBR TRAINING TPA Implementation April 2018

2 Agenda Medicare Manager Changes How to identify HICNs changing to MBIs How to maintain accurate Medicare information Transfer of documents and Dependent Verifications What will transfer and when to expect things to transfer Examples Employment Status Changes How to categorize people into the new statuses How to change an employees status and elect new benefits Policies and procedures when switching employment statuses Examples High Deductible Health Plan Transition How this impacts your Blue Cross NC invoice How members will be invoiced based on their employee status 2

3 Medicare Manager Changes 3

4 Medicare Manager Changes All Social Security numbers (SSNs) will be removed from all Medicare cards by April A new Medicare Beneficiary Identifier (MBI) will replace the SSN-based Health Insurance Claim Number (HICN) on the new Medicare cards for Medicare transactions like billing, eligibility status, and claim status. 4

5 Medicare Manager Changes These changes were processed at Blue Cross NC and updated in eenroll as shown below: There is no special messaging in eenroll about this update, as some members may not have received their new Medicare card yet. 5

6 Medicare Manager Changes In the future, members will be unable to add, edit, or remove Medicare information without calling eenroll or their HBR. 6

7 Transfer Functionality 7

8 Transfer Checklist Subscriber SSN and DOB are exact match to existing record in eenroll Dependents demographic information and verification status will transfer to the new group. Member has a unique login ID All documentation (regardless of status) for the subscriber and their dependents are transferred. Subscriber is terming from an active group and enrolling in the Retirement Systems. All currently enrolled dependents will be automatically enrolled in benefits in the Retirement Systems. 8

9 Example A I am an employee that: Currently has Employee Child coverage Is retiring effective 6/1 Has a spouse listed as a beneficiary What (if anything) will transfer for me? All Dependent Statuses(including spouse) and Documentation Auto enrollment into employee child coverage on State Retirement Systems (SRS) 9

10 Example B I am a dependent (age 25) that: Is now working as an employee in the same group as my parent. What (if anything) will transfer for me? Nothing will transfer since they started as a dependent 10

11 Example C I am a part-time employee with a TIN that: Is not currently enrolled in benefits Is transferring to a University teaching position Has recently received a SSN What (if anything) will transfer for me? Nothing will transfer since they will not have a matching SSN/TIN. 11

12 Employment Status Change 12

13 Enrollment & Billing Changes Process Changes at each Employing Unit How members are categorized for benefits will now be uniform across all groups Each group will need to update the employment status appropriately in eenroll for the correct enablement functionality Process Changes Invoice Changes at Blue Cross NC Invoices will include new employment statuses, benefit packages, and premium calculations Coding Changes in eenroll The existing 12 Month RIF Employee category will be changed to the Employee Status category. Invoice Changes Coding Changes 13

14 Employee Categorization This is how employees should map to the new Employment Statuses: FTE >=.75 Full Time LOA: Partially Paid* LOA: Fully Paid* FTE.5 <>.75 Part Time (PTE) Job Share FTE <.5 or N/A Not Eligible 12 Month RIF Non Perm Full Time Employees *Does not refer to research/scholarly leave 14

15 Employment Statuses Pre Implementation Current 12 month RIF enrollee category will be changed to the new employment status category. Current values will be mapped as follows: The Employment Status Category will be mapped in June 2018 and it will be required for newly enrolled employees in late June

16 Updating Employment statuses Effective date is required for any category change, whether it is processed manually or via a payroll file. 16

17 Updating Employment statuses Any benefits not enabled for the new employment status will be cancelled as of the day before the effective date and the new benefits will display: 17

18 Updating Employment Statuses cont d. Members will then be able to elect the coverage they would like based on what their status entitles them to be eligible for. HBR View Member View If no eligibility changes, this message will appear and no further action is needed: 18

19 Movement Rules Changes that are not allowed: Temp Full Time to RIF Temp Full Time to LOA Not Eligible to RIF Not Eligible to LOA RIF to LOA Temp Full Time to Temp Full Time Retiree Changes that use the following life events will generate a COBRA offer: Reduction in Hours Leave of Absence* Did Not Meet Medical Eligibility Requirements *if any coverage cancels Changes that open a new eligibility window: LOA to Full Time RIF to Full Time Temp to Full Time Not Eligible to Temp Not Eligible to Full Time 19

20 Before Movement Grid After Full Time Temp FT Temp FT Retiree RIF LOA Part Time Job Share Not Eligible Full Time * Temp FT Temp FT Retiree RIF LOA Part Time Job Share Not Eligible 20

21 HDHP Transition 21

22 High Deductible Health Plan Member Movement Mapping Migration Sync All members who are eligible for HDHP coverage as of June 2018 will be migrated to eenroll. Members with active coverage in Medcost will be mapped forward in August 2018 for the 2019 Open Enrollment There will be a weekly sync during Open Enrollment for newly eligible members being added into itedium to ensure they are able to change 2019 elections if they would like to add or remove eligible members for

23 Member invoices Members can pay online at Login: account number (without CG) Password: last 4 digits of their SSN If full payment is not received by the Grace Period End Date, the member will be terminated for nonpayment back to the last day coverage was fully paid for. Any partial payments will be refunded. Members should mail payments to: North Carolina State Health Plan Attention: Direct Bill Premium Payments PO Box St. Louis, Missouri

24 Member Nonpayment Timeline Members claims will continue to pay as long as the group is paying 100% of the invoice. If the member doesn t pay and is retroactively terminated, they will responsible for any claims paid during that time. 1/1/19 Member Invoice from itedium 12/10/18 2/1/19 Member Invoice from itedium 2/1/19 Invoice Due Date Member partial payments refunded 1/10/19 2/1/19 2/10/19 1/1/19 1/31/19 2/5/19 2/15/19 1/1/19 Invoice Due Date Member Grace Period End Date Member Termination Processed Credit on 3/1/19 Group Invoice for January and February

25 Group Invoice Changes Timeline 11/10/18 Dec Invoice from itedium 12/10/18 Jan Invoice with HDHP Members 12/5/18 Balance Transfer to Blue Cross NC 25

26 Direct Bill Payroll Deduct Group Invoice Changes Your group s invoice will have additional employment status codes and additional benefit package codes. For example, you will have employment status as follows: Code Description Group Pays Employer Amount Group Collects Employee Amount E Full Time (Default) Yes Yes T Part Time No Yes J Job Share 50% 50% + EE Cost U H F P Unemployed (RIF) Non Perm Full Time Non Perm Full Time Retiree Leave of Absence (Partially Paid) Yes No L Leave of Absence (Fully Paid) No No 26

27 Sample Invoice The new employee status displays in line with the existing statuses and the amounts calculate appropriately. 27

28 Reconciliation Changes You can sort and subtotal by Employee Status to do a quick reconciliation of your other statuses. 28

29 Example Scenarios 29

30 Example #1 I am an active employee that: Started a permanent position a week ago Works 40 hours a week What should my employment status be? Payroll Deduct: Full Time 30

31 Example #2 I am a retired employee that: Came back to work temporarily Works between hours a week What should my employment status be? Direct Bill: Non Perm Full Time (Retiree) 31

32 Example #3 I am an employee that: Is currently on workers comp awaiting a disability determination What should my employment status be? Direct Bill: LOA Fully Paid 32

33 Example #4 I am a permanent employee that: Is traveling more and voluntarily reduced my hours; I now work 25 hours a week What should my employment status be? Payroll Deduct: Part Time 33

34 Example #5 I am an employee that: Is currently on extended maternity leave with pay What should my employment status be? Direct Bill: LOA Partially Paid 34

35 Example #6 I am an employee that: Lost my permanent job due to lack of funding Previously worked 40 hours a week Accepted a temporary job until funding is received What should my employment status be? (COBRA notice sent) Direct Bill: Reduction in Force (RIF) Direct Bill: Non Perm Full Time 35

36 Example #7 I am an employee that: Lost my permanent job due to lack of funding Previously worked 40 hours a week What should my employment status be? Direct Bill: Reduction in Force (RIF) 36

37 Example #8 I am an employee that: Lost my contract job due to lack of funding Previously worked 20 hours a week What should my employment status be? Not Eligible 37

38 Questions? This presentation is for general information purposes only. If it conflicts with federal or state law, State Health Plan policy or your benefits booklet, those sources will control. Please be advised that while we make every effort to ensure that the information we provide is up to date, it may not be updated in time to reflect a recent change in law or policy. To ensure the accuracy of, and to prevent the undue reliance on, this information, we advise that the content of this material, in its entirety, or any portion thereof, should not be reproduced or broadcast without the express written permission of the State Health Plan.