UnitedHealthcare - Ancillary Only New Business Packet - Tennessee Group size of 2-50 Employees

Transcription

1 UnitedHealthcare - Ancillary Only New Business Packet - Tennessee Group size of 2-50 Employees Please note this packet is for groups that are domiciled in Tennessee. Please refer to or contact your UnitedHealthcare Account Executive, if your group is domiciled in another state. The following documents are included in this packet: New Submission Workflow - Provides the process steps and expected turn around times for a new submission. Ancillary Installation Requirements - Provides a list of all requirements by product type. Tax Guidelines - Use to determine the tax documents that need to be included in the submission. Benefit Options Checklist - Used at time of sale to communicate the products the group has elected. Employee Rights and Responsibilities - Each employee completing an application must receive a copy of these rights and responsibilities. Packaged Savings - Details on premium discounts that group s are eligible for when they purchase ancillary lines of coverage in addition to medical. See attachment tab in Adobe (left hand side towards bottom) for documents below: Enrollment Applications o Employer Application version # /09 o Enrollment Spreadsheet Preferred method to enroll membership at time of sale, unless product election mandates Individual Employee applications. o EE Application - version # /08 Employer and Employee Application Addendums - These forms are required for all Supplemental Life and Disability elections. o Employer Addendum version # /09 o Employee Addendum version # /09 Evidence of Insurability Employee Application - Must be completed when underwriting required for Life and Disability products with benefit amounts over Guarantee Issue Amounts. o EOI-UHIC-L-TN 7/04 Direct Debit Authorization Form - Employer form authorizing their premium to be debited from their bank account. o UHC Direct Debit Form Common Ownership Form - When an employer owns multiple companies and wants to cover two or more of them under one policy, this form must be completed in order to document the common ownership relationship Form - For UnitedHealthcare to cover a 1099 employee, the employer must complete a 1099 form. Employers may elect to offer coverage to their independent contractors (1099 employees), if the following conditions are met: o The maximum number of 1099 contractors may not exceed 25% of the total number of enrolled subscribers. o The business has a minimum of two regular, taxed employees who are applying. o The Independent Contractor paid by 1099 must work for the company on a full-time, year round basis. o The 1099 contractor must work a minimum of 30 hours per week. o o o The employer agrees to contribute the same amount of money toward the premium as regular taxed employees. The employer agrees to require the same waiting period for Independent Contractors as regular taxed employees. The employer agrees to extend the coverage offering to all Independent Contractors who meet these qualifications, including any future 1099 employees. The Independent Contractor form must list all 1099 employees. o If you have any questions please feel free to contact your UnitedHealthcare Account Executive or Sales Operations Specialist.

2 New Submission Workflow - Ancillary Only UnitedHealthcare of AR/TN Groups with 2-50 employees Note : All turn around times are business hours and/or days. During high volume periods, TATs may be longer. Step: 1 2 Case assigned to Sales Ops Specialist (SOS) hrs Confirmation of receipt and SOS notification sent to broker. Case reviewed for required documents. SOS sends Verification Approval along with the list of missing information. Broker must REPLY with their acceptance, so that history is shown. 3 Broker responds with their approval to the verification approval and provides all information requested for case installation. 4 SOS reviews information received from broker. 24 hrs Do we have required information for Case Installation? Yes - Go to Next Step No - sent to broker requesting missing information. Broker gets missing info and sends to SOS. SOS reviews within 24 hrs and proceeds to next step if all missing information has been received. 5 SOS submits the group to Case Installation. 24 hrs 6 Case Install releases the Reserved Policy # to Broker & SOS. 24 hrs 7 Case Install sends Install Summary to SOS. 72 hrs 8 SOS reviews Install Summary. 24 hrs Is the Install Summary Correct? Yes - Go to Next Step No - sent to Case Install requesting corrections. Case Install makes corrections and sends new Install Summary to SOS. SOS reviews within 24 hrs and proceeds to next step if all is correct. 9 SOS releases Install Summary to broker for approval. If response from broker is not received with 24 hrs, SOS assumes approval. 24 hrs 10 Broker sends changes or approval to SOS. Install Summary Approved? Yes - Go to next step. No - SOS sends change request to case installation. SOS receives new Install Summary, sends to broker for approval. Broker sends approval to SOS. 11 SOS sends Install Summary Approval to Case Installation. 4 hrs 12 Case Installation sends Welcome Letter to group, broker and SOS. 4 hrs Post Installation Activities: Actions: Broker completes New Submission Packet and submits to Knoxville Sales Office. Mail: 408 N. Cedar Bluff Rd., Ste. 400, Knoxville, TN Fax: (888) sbmeduw@uhc.com Group & Member info available thru Customer Service. 1 day Member RX Benefits are accessible. 2 days Members can register on myuhc.com. 3 days Permanent ID cards are sent to members and admin kit sent to the group days Group Policy and member Certificates of Coverage are available online. 15 days UHC SB Ancillary Only New Submission Workflow

3 UnitedHealthcare MidSouth Division Small Business Ancillary Installation Requirements Required Documents UHC Employer Application UHC Employee Application 3 Enrollment Spreadsheet L & D Employer Addendum 4 L & D Employee Addendum 4 UHIC EOI Application 5 Tax Documentation 7 Dental Prior Carrier Bills & Benefit Summary 8 Binder Check 9 Letter from Customer - including prime policy #, plan name and Eff. Date Processed by New Business (2-50) New Business (51-99) NBEA (2-99) 1 W/ Medical Stand W/ Medical Stand UHC RV Alone 2 UHC RV Alone UHC RV X X X X X X X X 3 X 3 X X X X X 6 X X 4 X 4 X 4 X 4 X 4 X 4 X 4 X 4 X 4 X 4 X 4 X 4 X 4 X 5 X 5 X 5 X 5 X 5 X 5 X 5 X 5 X 7 X 7 X 7 X 8 X 8 X 8 X 8 X 8 X 8 X 8 X 8 X 9 X 9 X 9 X 9 Sales Ops Sales Ops X AC/AA/RAE 10 Sales Ops NBEA (New Business Existing Account) - adding products to a existing policy. Stand Alone Life & AD&D not allowed for Groups of 2-5 subscribers. The UHC Employee Application with 14 medical questions is required for Basic Life and AD&D elections over the Guaranteed Issue Amounts. Employer and Employee L & D Addendums are required for Supplemental Life and Disability Products. Evidence of Insurability applications are required for Basic Life and AD&D benefit amounts over the Guarantee Issue Limits. Please note that the EOI applications may also be required for Employee and Dependent Supplemental Life and Disability products - based on benefit amounts - contact UHC Account Executive for If Ancillary enrollment is the same as the current UHC policy's enrollment - enrollment spreadsheet not needed. Add statement to letter from customer to add ancillary product to current enrollment. See Tax Guidelines/Chart for requirements based on type of business. To waive the Dental Waiting Periods we must have documentation that shows there was coverage in effect 12 months prior to the effective date of the coverage. We will need a current prior carrier invoice and the prior carrier invoice for 12 months prior to the effective date of this policy, and either a summary plan document or certificate of coverage. Binder checks are not required for Voluntary (employer paying 49 percent or less of the premium) - Dental, Vision, Life and Disability products. AC - Account Consultant, AA - Account Advisor, RAE - Renewal Account Executive. UHC SB Ancillary Installation Requirements 0509

4 Tax Guidelines All Groups with 2-50 employees must provide documentation of a Employer / Employee relationship for all employees that are eligible for coverage. Standard required documents are the most recent Quarterly Wage and Tax Report (QWT)*, most recent Two Week Payroll**, and Proof of Ownership. See below for specifics by Group type. Group Type Standard Groups Husband / Wife Groups not required to file a QWT Owners Only Groups not required to file a QWT New Groups that have not been in business long enough to have filed a QWT Churches PEO**** Professional Employment Organization aka: leasing co., employee leasing co. Groups of 2 to 5 Eligible QWT *** (IF OWNERS NOT LISTED ON QWT) (If spouse does not appear on ownership documentation: to verify full-time employment w/group) Quarterly IRS Form 941 QWT Groups of 6-50 Eligibile QWT OR Quarterly IRS Form 941 QWT OR * ** Please note all State Quarterly Wage and Tax Reports must be reconciled to ensure all employee's on the report are accounted for. Please do this by indicating the employment or eligibility status for each employee with these abbreviations: A= any employee submitting an Application, W=Waiving, P/T = Part-Time, T=Terminated, S = Seasonal, WP=Waiting Period. Two week payrolls must list the company name, reflect current pay period and include a list of all employee's indicating wages paid, withholdings, and a grand total. Handwritten or estimated payroll, individual payroll/ pay stubs or W-2, W-3, W-4, W-9's are not accepted. *** Please note for groups with 2-5 eligible employees, when owners, electing coverage, are not listed on the QWT report, proof of ownership is required. **** Required eligibility information for PEO's will include the standard documents for any small group: A. Documentation must provide information that sufficiently verifies each employee s (including those leased) eligibility; B. United Healthcare must be the sole provider of coverage offered to all the employees; C. If the information is provided by the PEO or Leasing Company on the employer s behalf, the data must be specific to the employer; D. UnitedHealthcare will not accept a list of all the PEO s leased employees. The documentation must be limited to those leased employees who are co-employed by the applying employer. Proof of Ownership Guidelines (if required) Group Type Corporation Partnership/LLP In Business Over 1 Year K-1 (Form 1120S) for all enrolling Owners/Partners K-1 (Form 1065) for all enrolling partners OR Partnership Agreement signed by all partners In Business Less Than 1 Year Articles of Incorporation filed with the state listing all enrolling officers' names Partnership Agreement signed by all partners LLC Sole Proprietorship Farms LLC Agreement signed by all managers/members/owners who are applying OR copies of tax returns based on how LLC was formed IRS Schedule C IRS Schedule F LLC Agreement signed by all managers/members/owners listing all applying owners/partners/members Business License IRS Schedule F Tax Guidelines External 0509

5 UnitedHealthcare of the Mid South Benefit Option Checklist Please check the desired Plan(s). Include this checklist with the Employer Application. See the summary plan document for complete description of benefits. Step 1 Company Name Effective Date Step 2 Choose Medical Product None UnitedHealthcare UnitedHealthcare of the River Valley Step 3 Choose the Medical and Prescripton Plan Options None Single Option Plan Rx Plan Dual Option* Base Plan Rx Plan Buy Up Plan Rx Plan * Please indicate on employee enrollment form which plan each employee is enrolling in OR include a census indicating choice. Multi-Policy** RV Plan Rx Plan UHC Plan Rx Plan ** Please contact Account Executive with any questions concerning Multi-Policy Step 4 Choose Out of Network Benefit UHC: POS benefits are determined by plan design. RV: POS No POS Step 5 Choose Optional Riders None UHC: Refer to Employer Application if Riders are available in state where group is domiciled. RV: Chiropractic : $0 $5 $10 $15 $20 $25 Mini Vision (Virginia Only): $15 $20 Step 6 Choosing an HRA or HSA None UHC: Are you adding an HRA with UnitedHealthcare Administration? If yes please complete the appropriate HRA Benefit Form (HRA Standard / HRA Select). RV: Are you purchasing an HSA product? If so, will you be using Optum Health Bank for the HSA Administration? If yes, please complete the Optum Health Bank Notification Form. Please send all employee Optum Health Applications to Optum Health Bank. Employers are responsible for setting up their own HRA / HSA administration. At this time it is not available through UnitedHealthcare. Step 7 Choose a Dental Plan (TN/VA - see Dental Rate Card) None Single Option Dental Plan Code Dual Option Base Plan Code Buy Up Plan Code ***To waive the Dental Waiting Periods we must have documentation that shows there was coverage in effect 12 months prior to the effective date of the coverage. We will need a a current prior carrier invoice and an invoice from 12 months prior to the effective date of this policy, and either a summary plan document or certificate of coverage. Continued on page 2 1

6 UnitedHealthcare of the Mid South Benefit Option Checklist (continued) Step 8 Choose a Vision Plan (TN/VA - see Vision Rate Card) None 100% Employer Paid Voluntary Plans Dependent Buy Up Plans ** V0001 V0002 V0005 V0006 V0009 V0010 V0003 V0004 V0007 V0008 V0011 V0012 ** 100% employer paid single covg / 0% employer paid dependent covg. Step 9 Choose Life and AD&D Plan(s) (Refer to Minimum/Maximum Table below) Employee Life: Yes No Option A - $ Flat amount for each employee Option B - Flat amount based on class of employee Attach list of employees by class, indicating amount of coverage to be provided to each class Option C - X salary for all employees (1X salary or 2X salary) Dependent Life: Yes No Option A - Spouse - $4,000, Child $2,000 Option B - Spouse - $2,000, Child $1,000 Option C - Spouse - $7,500, Child $3,750 # of Lives Minimum Maximum Guarantee Issue** Life/AD&D Minimum/Maximum Table 2-5* $15,000 $15,000 $15,000 $15,000 $50,000 $175,000 $250,000 $350,000 $25,000 $50,000 $100,000 $175,000 * Stand Alone Life & AD&D Benefits are not available to groups of 2-5 employees. ** Life & AD&D Benefit Amounts over the Guaranteed Issue amount requires medical underwriting, therefore the 14 medical question employee application is required for Basic Life & AD&D products, and the Evidence of Insurability Application is required for Supplemental Life products. Step 10 Choose STD/LTD/Voluntary or Supplemental Life Benefits ** None ** Please note all elections for Supplemental Life and Disability products require the Employer and Employee Application Addendums to be completed. ** Short Term Disability Long Term Disability Plan Plan Supplemental Employee Life/AD&D Supplemental Dependent Life/AD&D Plan Plan ** Evidence of Insurability (EOI) Employee applications may be required when purchasing voluntary or supplemental Life & AD&D products, determined by benefit amounts. Step 11 Signature By signing below, the undersigned agrees that the above selected benefits will be provided for the members of the employer group. Such selections)) will be incorporated into the Group Policy and Certificate, which are the governing documents. In addition, I verify that all employees applying for or waiving coverage are eligible to do so. Preliminary rates will be adjusted to reflect actual enrollment and underwriting risk assignment for final rates. Rates are not final until the Benefit and Premium Confirmation Form is returned. Group Administrator Broker Signature Signature Date Date DO NOT CANCEL YOUR EXISTING COVERAGE UNTIL YOU RECEIVE WRITTEN NOTIFICATION OF APPROVAL 2

7 By completing this application: I (we) authorize all providers of health services or supplies and any of their representatives to give the following to the HMO/insurance company(ies): any available information about the medical history, condition or treatment of any person named in this request. I (we) authorize the HMO/insurance company(ies) to use this information to determine eligibility for medical coverage and eligibility for benefits under an existing policy. I (we) also authorize the HMO/insurance company(ies) to give this information to its (their) representatives or to any other organization for the reason notified above. I (we) agree that this authorization is valid for 30 months from the date of this application. I (we) know that I (we) have the right to ask for and receive a copy of this authorization. I understand that the Certificate of Coverage or Summary Plan Description and other documents, notices and communications regarding my coverage may be transmitted electronically. I (we) have not given the agent or any other persons any health information not included on the application. I (we) understand that the HMO/insurance company(ies) is not bound by any statements I (we) have made to any agent or to any other persons, if those statements are not written or printed on the application and any attachments. I have a continuing obligation to report changes in health status (e.g. received medical advice, diagnosis, care or treatment) after I sign the enrollment form and before receipt of my identification card. Confidentiality Make sure your employer has completed the To be completed by the employer section of the enrollment form before you begin to complete your portion of the form. If you do not wish to disclose personal medical information through this form to anyone other than UnitedHealthcare and its affiliates and representatives for underwriting and other purposes permitted by law, you may complete all information on the enrollment form, then insert and seal the form in an envelope before returning it to your employer or broker. Your rights and responsibilities / United HealthCare Services, Inc.

8 Important information In order to make choices about your coverage and treatment, we believe that it is important for you to understand how your plan operates and how it may affect you. In an ever-changing environment, the information can never be complete, and we urge you to contact us if the information in your Summary Plan Description, Certificate of Coverage or other materials does not answer your questions. Further information is available at myuhc.com. 1. We do not provide medical services or make treatment decisions. We help finance and/or administer the health benefit plan in which you are enrolled. That means: We make decisions about whether the health benefit plan you chose will reimburse you for care that you may receive. We do not decide what care you need or will receive. You and your physician make those decisions. 2. We may enter into arrangements where another entity carries out some of our duties, but those entities must operate consistently with our commitment to your plan. 3. We contract with networks of physicians and other providers. Our credentialing process confirms public information about the providers licenses and other credentials, but does not assure the quality of the services provided. 4. Physicians and other providers in our networks are independent contractors and are not our employees or agents. We do not control nor do we have a right to control your physician s treatment or plan. 5. We may enter into agreements with your physician or other provider to share in the cost savings that our approach may generate. We encourage providers in our network to disclose the nature of those arrangements to you. If they do not, we encourage you to talk to your physician about these arrangements. 6. We encourage physicians to talk with you about medical care you or your physician think might be valuable. Pre-existing conditions If you or your covered dependents have received medical advice, care or treatment for an injury or sickness before beginning coverage or a waiting period under your health plan that injury or sickness may be considered a pre-existing condition. Under federal law, a group health plan may look back for a period up to six months prior to the date coverage begins or, if earlier, the date a waiting period begins to determine if a pre-existing condition exists. A group health plan may exclude benefits for pre-existing conditions for up to 12 months (18 months for late entrants) from the above date. Pregnancy is not a pre-existing condition. A pre-existing condition will not apply to a newborn child, adopted child or a child placed for adoption prior to age 18, if the child is enrolled in a plan within 30 days of birth, adoption or placement for adoption. Genetic information is not considered a pre-existing condition unless there is a specific diagnosis related to the information. Under federal law, a group health plan must reduce a pre-existing condition exclusion period by the same number of days you or your dependents were covered under prior health plans, unless there has been a significant break in coverage. If you or your dependents have a break in coverage of 63 or more days (including a newborn child, adopted child or child placed for adoption), coverage under prior plans will not be used to reduce a pre-existing condition exclusion period. In determining whether there has been a break in coverage of 63 days or more, plans may not include a waiting period you or your dependents may have had to satisfy. To receive credit for coverage under prior health plans (and thereby reduce or eliminate any pre-existing condition exclusion), you must show proof of prior coverage. You have the right to request a Certificate of Prior Creditable coverage from your prior employer or insurer. If necessary, UnitedHealthcare will help you obtain this information. Statement of affirmation and authorization to obtain and disclose information in connection with eligibility for medical coverage I understand that I am completing a joint life and health application and that each response must be complete and accurate. I (we) request the indicated group medical and/or life coverage for myself and, if the plan provides, for my dependents. I authorize any required premium contributions to be deducted from earnings.