Administrative Guide Provided to assist you in the administration of your benefit plan Assurant Employee Benefits 2323 Grand Boulevard Kansas City, MO 64108 800.733.7879 Please Note: This administrative guide includes all products that are offered by Union Security Life Insurance Company. Every product listed in this guide may not be applicable to your organization. In New York, insurance and prepaid products are underwritten or provided by Union Security Life Insurance Company of New York, which is licensed in NY and has its principal place of business in Syracuse, NY. This Administrative Guide is provided to assist you in the administration of your plan. Please see group policy or product for controlling plan features and benefits.
Table of Contents Please Note: This administrative guide includes all products that are offered by Union Security Life Insurance Company of New York. Some of these benefits may not apply to your policy. Enrollment Forms Extended Employee Application... 3 Dental Application... 4 Voluntary Indemnity Dental & Prepaid Applications... 5 Voluntary Life Application... 6 Voluntary LTD Application... 7 Vision Application... 8 HIPAA Authorization (use anytime medical questions are completed)... 9 Where to Send Claims Claim Addresses for all Benefits and Locations... 10 Dental Claims... 11 Statement of Loss... 12 Life Claims... 13 Conversion... 14 Portability... 15 Beneficiary Changes... 16 Long-Term Disability Claims... 17 Conversion... 18 Short-Term Disability Claims... 19 Frequently Asked Q & A for Pregnancy Claims... 20 State Disability Claims... 21 Vision Claims... 22 Billing Schedule & Contacts... 23 Mobile Apps Benefit Tools...24 Online Advantage Online Advantage for Employers... 25 Online Advantage for Members... 27 Contacts Customer Advocacy Contact Sheet... 29 Who should I contact?... 31 2
Extended Enrollment Application with Health Questions Sample and Instructions This form can be accessed on our website for employers: www.assurantemployeebenefits.com/, then select For Employers to open the Employer Page and on the left navigation select Forms. This will then allow you to scroll to the correct form. Online Advantage users may access all their policy specific forms from their Online Advantage account under "Documents and Reports", choose "policy forms." When to use this form: 1) This form can be used to enroll all lines of coverage with the exception of pre-paid dental. 2) The employee health questions found on the second page must be completed for life and disability coverage for any late enrollee or when applying for amounts over the guarantee issue. A late enrollee is anyone that is enrolling after 31 days of becoming eligible for that benefit. This includes anyone applying for coverage during any annual enrollment period. If any of these situations do not apply, you may utilize the basic employee application also found on our website. 3) You may also use this form for any submitted changes. Changes and terminations may also be emailed to your customer advocacy team or entered online. There are no specific change or termination forms. Please include policy number, employee name and employee termination date when sending in terminations. Where to send additions, terminations and changes: Process your changes online at www.assurantemployeebenefits.com Internet E-mail address: NewYorkCustomerAdvocacy@assurant.com Fax: 888.208.2323 Mail: Union Security Life Insurance Company of New York Administered by: Assurant Employee Benefits Attention: Customer Advocacy P.O. Box 981624 El Paso, TX 79998-1624 3
Dental Only Enrollment Application Sample and Instructions Employer Paid If an employee is enrolling in a non-voluntary Assurant Employee Benefits dental plan after declining coverage that was initially offered to him/ her, late entrant penalties* will apply. This applies during the annual enrollment period as well. The late entrant penalties can be waived if the election is due to a loss of coverage from a life event. This form can be accessed on our website for employers: www.assurantemployeebenefits.com/, then select For Employers to open the Employer Page and on the left navigation select Forms. This will then allow you to scroll to the correct form. Online Advantage users may access all their policy specific forms from their Online Advantage account under "Documents and Reports", choose "policy forms." When to use this form: 1) This form can be used to enroll all dental coverage with the exception of pre-paid dental. 2) You may also use this form for any submitted changes. Changes and terminations may also be emailed to your customer relations team or entered online. There are no specific change or termination forms. * Late entrant penalties for employees not enrolling within 31 days of becoming eligible for benefits for any Assurant Employee Benefits non-voluntary dental plan are as follows. Preventive Care No waiting periods Basic Restorative Services 6 months Basic Non-Restorative Services 12 months Major Services 12 Months Orthodontic Services (if applicable) 12 Months If your plan contains waiting periods, those waiting periods will still apply. Where to send additions, terminations and changes: Process your changes online at www.assurantemployeebenefits.com Internet E-mail address: NewYorkCustomerAdvocacy@assurant.com Fax: 888.208.2323 Mail: Union Security Life Insurance Company of New York Administered by: Assurant Employee Benefits Attention: Customer Advocacy P.O. Box 981624 El Paso, TX 79998-1624 4
Dental Only Enrollment Application Sample and Instructions Voluntary Prepaid Dental Enrollment Form Voluntary Indemnity Dental Enrollment Form Request these forms from your Customer Advocacy Team. When to use this form: 3) This form can be used to enroll all dental coverage with the exception of pre-paid dental. 4) You may also use this form for any submitted changes. Changes and terminations may also be emailed to your customer relations team or entered online. There are no specific change or termination forms. * Late entrant penalties for employees not enrolling within 31 days of becoming eligible for benefits for any Assurant Employee Benefits non-voluntary dental plan are as follows. Preventive Care No waiting periods Basic Restorative Services 6 months Basic Non-Restorative Services 12 months Major Services 24 Months Orthodontic Services (if applicable) 12 Months If your plan contains waiting periods, those waiting periods will still apply. Where to send additions, terminations and changes: Process your changes online at www.assurantemployeebenefits.com Internet E-mail address: NewYorkCustomerAdvocacy@assurant.com Fax: 888.208.2323 Mail: Union Security Life Insurance Company of New York Administered by: Assurant Employee Benefits Attention: Customer Advocacy P.O. Box 981624 El Paso, TX 79998-1624 5
Voluntary Life Enrollment Form Sample and Instructions This form can be accessed on our website for employers: www.assurantemployeebenefits.com/, then select For Employers to open the Employer Page and on the left navigation select Forms. This will then allow you to scroll to the correct form. Online Advantage users may access all their policy specific forms from their Online Advantage account under "Documents and Reports", choose "policy forms." When to use this form: 1) This form can be used to enroll voluntary life coverage. 2) The employee health questions found on the second page should be completed for any late enrollee or for any employee/dependent electing over the guarantee issue amount listed in your policy. A late enrollee is anyone that is enrolling after 31 days of becoming eligible for this benefit including any elections or changes made during your annual enrollment period. Note: You will also receive forms during your annual enrollment period for any new elections, changes or terminations along with instructions on annual enrollment provisions. Where to send additions, terminations and changes: Process your changes online at www.assurantemployeebenefits.com Internet E-mail address: NewYorkCustomerAdvocacy@assurant.com Fax: 888.208.2323 Mail: Union Security Life Insurance Company of New York Administered by: Assurant Employee Benefits Attention: Customer Advocacy P.O. Box 981624 El Paso, TX 79998-1624 6
Voluntary Long-Term Disability Enrollment Form Sample and Instructions With the exception of new hires, employees may elect or make changes to coverage during the annual enrollment period only. If an employee does not enroll for coverage within 31 days of becoming eligible, they must wait until the following annual enrollment period, and will be subject to the preexisting conditions provision at that time. This form can be accessed on our website for employers: www.assurantemployeebenefits.com/, then select For Employers to open the Employer Page and on the left navigation select Forms. This will then allow you to scroll to the correct form. Online Advantage users may access all their policy specific forms from their Online Advantage account under "Documents and Reports", choose "policy forms." When to use this form: 1) This form can be used to enroll voluntary long-term disability coverage. Note: You will also receive forms during your annual enrollment period for any new elections, changes or terminations along with instructions on annual enrollment provisions. Where to send additions, terminations and changes: Process your changes online at www.assurantemployeebenefits.com Internet E-mail address: NewYorkCustomerAdvocacy@assurant.com Fax: 888.208.2323 Mail: Union Security Life Insurance Company of New York Administered by: Assurant Employee Benefits Attention: Customer Advocacy P.O. Box 981624 El Paso, TX 79998-1624 7
Vision Enrollment Form Sample and Instructions With the exception of new hires, employees may elect or make changes to coverage during the annual enrollment period only. If an employee does not enroll for coverage within 31 days of becoming eligible, they must wait until the following annual enrollment period. This form can be accessed on our website for employers: www.assurantemployeebenefits.com/, then select For Employers to open the Employer Page and on the left navigation select Forms. This will then allow you to scroll to the correct form. Online Advantage users may access all their policy specific forms from their Online Advantage account under "Documents and Reports", choose "policy forms." When to use this form: 1) This form can be used to enroll all vision coverage. 2) You may also use this form for any submitted changes. Changes and terminations may also be emailed to your customer advocacy team or entered online. There are no specific change or termination forms. Note: You will also receive forms during your annual enrollment period for any new elections, changes or terminations along with instructions on annual enrollment provisions. Where to send additions, terminations and changes: Process your changes online at www.assurantemployeebenefits.com Internet E-mail address: NewYorkCustomerAdvocacy@assurant.com Fax: 888.208.2323 Mail: Union Security Life Insurance Company of New York Administered by: Assurant Employee Benefits Attention: Customer Advocacy P.O. Box 981624 El Paso, TX 79998-1624 8
HIPAA Authorization Sample and Instructions This form can be accessed on our website for employers: www.assurantemployeebenefits.com/, then select For Employers to open the Employer Page and on the left navigation select Forms. This will then allow you to scroll to the correct form. Online Advantage users may access all their policy specific forms from their Online Advantage account under "Documents and Reports", choose "policy forms." 9
Claims Contact Information for All Benefits By Location Dental Claims New York Union Security Life Insurance Company of New York Toll Free: 800.442.7742 Administered by: Assurant Employee Benefits Fax: 563.242.0184 Dental Claims P.O. Box 2941 Clinton, IA 52733-2941 Life and Disability Claims New York Union Security Life Insurance Company of New York Toll Free Number: 888.901.6377 Administered by: Assurant Employee Benefits Fax Number: 816.881.8967 P.O. Box 419244 Email: lifeclaims@assurant.com Kansas City, MO 64141 Disability Claims Email Contacts Utilize this address to submit a new claim: disabilityclaimonlinesubmissions@assurant.com Utilize this address for all inquiries and questions: disabilityclaims@assurant.com Vision Claims Contacts Toll Free VSP Number: 800.877.7195 VSP Website: www.vsp.com 10
Dental Claim Form Sample and Instructions Our dental claim statement is provided for your use but is not required in order to file claims with us. Forms provided by the dental office or copies of statements from the dental office are sufficient to pay claims. This form can be accessed on our website for employers: www.assurantemployeebenefits.com/, then select For Employers to open the Employer Page and on the left navigation select Forms. This will then allow you to scroll to the correct form. Online Advantage users may access all their policy specific forms from their Online Advantage account under "Documents and Reports", choose "policy forms." Additional Notes/Instructions: 1) A pre-estimate is recommended for dental treatments expected to exceed $300 so the claimant may understand his or her payment responsibility before treatment is rendered. 2) Claims data can be accessed at the member level by the member accessing our online site at www.assurantemployeebenefits.com/, then select For Members to open the Member page. Members can register for an account or if they already have an account established, they can sign in and view their claims data. Signing up for an account takes only a few minutes. 3) Claims can be mailed to the following address, filed electronically using Payer ID #70408, or faxed. Union Security Life Insurance Company of New York Fax: 563.242.0184 Administered by: Assurant Employee Benefits Dental Claims P.O. Box 2941 Clinton, IA 52733-2941 4) Our Claims Department can also be contacted at 800.442.7742 11
Dental Statement of Loss Due to Life Event Sample and Instructions If a member is enrolling in the dental plan after declining coverage that was initially offered to him/her, the late entrant penalties can be waived if the election is due to a loss of coverage from a life event. Please provide the details of the life event on this form to have the member be considered a timely applicant. This form can be accessed on our website for employers: www.assurantemployeebenefits.com/, then select For Employers to open the Employer Page and on the left navigation select Forms. This will then allow you to scroll to the correct form. Online Advantage users may access all their policy specific forms from their Online Advantage account under "Documents and Reports", choose "policy forms." Additional Notes/Instructions: 1) This form only applies to non-voluntary dental plans. 2) Application for waiver of the Late Entrant Limitation must be made within 31 days of the Life Event. 3) Life Events include the following: a. Divorce b. Legal Separation c. Death of a spouse d. Loss of dependent status (e.g. child attains limiting age) e. Significant change in employment status (loss of job) or insurance coverage (loss of coverage) for the employee or dependent. 4) You must attach proof of prior coverage (ID card, Explanation of Benefits, etc.) to this Statement. The above form along with proper documentation can be submitted to the following: Union Security Life Insurance Company of New York Administered by: Assurant Employee Benefits Customer Advocacy P.O. Box 419262 Kansas City, MO 64141-6262 12
Life, Dependent Life and AD&D Claim Form Sample and Instructions This form can be accessed on our website for employers: www.assurantemployeebenefits.com/, then select For Employers to open the Employer Page and on the left navigation select Forms. This will then allow you to scroll to the correct form. Online Advantage users may access all their policy specific forms from their Online Advantage account under "Documents and Reports", choose "policy forms." Instructions for filing a life claim: 1) Complete the above form found on our website Sections A through E along with beneficiary sections F through H will all need to be completed. Section C2 will also need to be completed if the claim is a dependent of an employee. 2) Include with your employee/dependent life claim the following items: Group Policyholder Statement and Beneficiary Statement(s) A certified copy of the death certificate A copy of the employee s enrollment card, if available A copy of all beneficiary changes, if applicable 3) If filing an Accidental Death and Dismemberment claim, please also include the following items if possible: Police Report Medical Examiners Report Newspaper Clippings Please send life claims statement and beneficiary statement along with any other required documentation noted above to any of the following. If you are faxing or emailing in your claim, we will require an original certified copy of the death certificate in the mail. Postal Address: Street Address: Toll Free/FAX: Union Security Life Insurance of New York Union Security Life Insurance of New York 888.901.6377 Administered by: Assurant Employee Benefits Administered by: Assurant Employee Benefits 816.881.8967 Group Life Benefits Group Life Benefits P.O. Box 419244 P.O. Box 419244 Kansas City, MO 64141-6052 Kansas City, MO 64141-605 13
Life Conversion Notification Sample and Instructions Life Conversion is available on both our Basic Life and Voluntary Life Plans This form can be accessed on our website for employers: www.assurantemployeebenefits.com/, then select For Employers to open the Employer Page and on the left navigation select Forms. This will then allow you to scroll to the correct form. Online Advantage users may access all their policy specific forms from their Online Advantage account under "Documents and Reports", choose "policy forms." Please note the following: 1) Application must be completed and sent to Assurant Employee Benefits along with the first full premium within 31 days after the termination date indicated on the conversion form. 2) Our Conversion Department will supply the applicant with a conversion enrollment form and a conversion rate grid. 3) Our Conversion Department can also be contacted at 866.909.6065 for conversion information instead of utilizing the above form. 4) No medical examination is required to convert coverage currently in-force. 5) This notice, once completed, can be mailed to the following address: Union Security Life Insurance Company of New York Administered by: Assurant Employee Benefits Life Conversion Department P.O. Box 219304 Kansas City, MO 64121-9304 14
Life Portability Notification Sample and Instructions Life Portability is available on Voluntary Life Plans only This form can be accessed on our website for employers: www.assurantemployeebenefits.com/, then select For Employers to open the Employer Page and on the left navigation select Forms. This will then allow you to scroll to the correct form. Online Advantage users may access all their policy specific forms from their Online Advantage account under "Documents and Reports", choose "policy forms." Please note the following: 1) Application must be completed and sent to Assurant Employee Benefits along with the first full premium within 31 days after the termination date indicated on the portability form. 2) Our Portability Department will supply the applicant with a portability enrollment form and portability rates. 3) Our Portability Department can also be contacted at 866.909.6065 for portability information instead of utilizing the above form. 4) This notice, once completed, can be mailed to the following address: Union Security Life Insurance Company of New York Administered by: Assurant Employee Benefits Life Portability Department P.O. Box 219304 Kansas City, MO 64121-9304 15
Life Beneficiary Change Form Sample and Instructions Beneficiary information can be updated at any time during the year - an employee does not need to wait until the annual enrollment period. It is always a good idea to remind your employees to update their beneficiary information if they have any kind of life status change throughout the year. This form can be accessed on our website for employers: www.assurantemployeebenefits.com/, then select For Employers to open the Employer Page and on the left navigation select Forms. This will then allow you to scroll to the correct form. Online Advantage users may access all their policy specific forms from their Online Advantage account under "Documents and Reports", choose "policy forms." General Provisions: 1) Beneficiary information can be kept on file with you. We do not need copies of this information unless there is a claim filed. 2) If there is no beneficiary entitled to payment in accordance with the designation, payment will be made in the following order: spouse of the insured if living; otherwise, in equal shares to the then living children of the insured, if any; or, if none, to the parents of the insured, in equal shares or to the survivor of them; or if none, to the executors or administrators of the insured s estate. 3) If any Primary or Secondary Beneficiary dies before the insured, then that beneficiary s share will be distributed equally among the other surviving beneficiaries within the same Primary or Secondary designation, unless the insured indicates otherwise in writing. 16
Long-Term Disability Claim Form Sample and Instructions This form can be accessed on our website for employers: www.assurantemployeebenefits.com/, then select For Employers to open the Employer Page and on the left navigation select Forms. This will then allow you to scroll to the correct form. Online Advantage users may access all their policy specific forms from their Online Advantage account under "Documents and Reports", choose "policy forms." Instructions for filing a long-term disability claim: 1) There are three sections of this form that will need to be completed. Employer Claim Statements Parts 1 and 2. The questions contained in this section go over the employee s last day worked, current income and current job duties. This will need to be completed by you as the employer. Claimant Statements Parts 1 and 2. The questions contained in this section go over basic employee information, questions regarding the disability, income from other sources and current education, experience and training. This section will need to be completed by the employee. Attending Physician s Initial Statement of Disability This will need to be completed by the employee s attending physician. This section includes detailed questions regarding the disability. Please collect all parts of claim including Physician s Statement to submit to Assurant Employee Benefits at one time. This will help to speed up the processing of the claim. 2) Claims can be mailed, faxed or emailed: Union Security Life Insurance Company of New York Fax: 866.439.1695 Administered by: Assurant Employee Benefits Disability Claims PO Box 419244 Kansas City, MO 64141-6244 Email: disabilityclaimonlinesubmissions@assurant.com 3) Our Claims Department can also be contacted at 888.901.6377. Note: The employee should also complete the DISABILITY-HIPAA Authorization for Release of Health Information. This will be necessary for us to obtain any further medical data to determine claim eligibility. If this is not completed, processing of the long-term disability claim can be delayed. 17
Long-Term Disability Conversion Form Sample and Instructions This form can be accessed on our website for employers: www.assurantemployeebenefits.com/, then select For Employers to open the Employer Page and on the left navigation select Forms. This will then allow you to scroll to the correct form. Online Advantage users may access all their policy specific forms from their Online Advantage account under "Documents and Reports", choose "policy forms." Please note the following: 1) Application must be completed and sent to Assurant Employee Benefits along with the first full premium within 31 days after the termination date indicated on the conversion form. The conversion coverage is effective on the day following the date the person s Long-Term Disability Insurance terminates. 2) The conversion rate of benefit will match the in force rate of benefit under the group policy, subject to a maximum rate of benefit of 60% and $1,000. 3) The benefit will be based upon the monthly earnings from the group policyholder immediately prior to termination of employment. 4) The conversion privilege is provided without proof of good health, but is subject to a pre-existing conditions limitation. 5) Our Conversion Department can also be contacted at 866.909.6065 for conversion information instead of utilizing the above form. 6) This notice, once completed, can be mailed to the following address: Union Security Life Insurance Company of New York Administered by: Assurant Employee Benefits LTD Portability Department P.O. Box 219304 Kansas City, MO 64121-9304 18
Short-Term Disability Claim Form Sample and Instructions Please also see frequently asked questions and answers on short-term disability pregnancy claims. These are the most frequently incurred disability claims and our Q&A sheet should be able to answer many of your questions. This form can be accessed on our website for employers: www.assurantemployeebenefits.com/, then select For Employers to open the Employer Page and on the left navigation select Forms. This will then allow you to scroll to the correct form. OA users may access all their policy specific forms from their OA account under Tools for You. Click maintain policy and then click policy forms. Instructions for filing a short-term disability claim: 1) There are three sections of this form that will need to be completed. They are as follows: Employer Claim Statement Part 1. The questions contained in this section of the claim form address the employee s last day worked, current income and tax information. This will need to be completed by you as the employer. Claimant Statement Part 1. The questions contained in this section go over basic employee information, questions regarding the disability, income from other sources and physician information. This section will need to be completed by the employee. Attending Physician s Initial Statement of Disability This will need to be completed by the employee s attending physician. This section includes detailed questions regarding the disability. Please collect all parts of claim including Physician s Statement to submit to Assurant Employee Benefits at one time. This will help to speed up the processing of the claim. 2) Claims can be mailed, faxed or emailed: Union Security Life Insurance Company of New York Fax: 866.439.1695 Administered by: Assurant Employee Benefits Disability Claims PO Box 419244 Kansas City, MO 64141-6244 Email: disabilityclaimonlinesubmissions@assurant.com 3) Our Claims Department can also be contacted at 877.829.6791. Note: The employee should also complete the DISABILITY-HIPAA Authorization for Release of Health Information. This will be necessary for us to obtain any further medical data to determine claim eligibility. If this is not completed, processing of the long-term disability claim can be delayed. 19
Frequently Asked Questions & Answers Short-Term Disability Claims Process for Pregnancy Claims Who is responsible for completing/filing the disability claim? Three parties are responsible for completing the short-term disability claims statement. One section is the responsibility of the employer, the second is the responsibility of the claimant and the third is the responsibility of the claimant s physician. The claimant is responsible for getting the physician s portion to their office to be completed. All three portions can then be mailed or faxed to Assurant Employee Benefits disability claims center by either the claimant or employer. How early can a pregnancy claim be filed? The pregnancy claim may be filed prior to the claimant s actual delivery date but once the claimant delivers, we will need to obtain that delivery date from the physician in order to complete the processing of the claim. We are unable to process the claim without the actual delivery date. How many weeks of benefits are paid for a pregnancy claim? Up to six weeks of postpartum disability is allowed for routine pregnancies. Up to six weeks is also allowed on C-section deliveries for claimants working in sedentary occupations. An eight-week recovery period is allowed on C-section deliveries for claimants working occupations in the light to heavy range. Disability periods of lesser or greater length may be warranted by the medical and vocational factors specific to a given claim. Please note: The qualifying period will always be deducted from the benefit duration periods stated above. How often are benefits paid? Benefits are calculated on a weekly basis but are paid bi-weekly. Please also note, however, if we have the return to work date when the disability benefit is paid, we can pay that benefit in one lump sum payment. Where will the disability check(s) be mailed? Checks will be mailed directly to the address you provide on the claim form either directly to the employee or to the employer. 20
State Disability Claim Form Sample and Instructions This form can be accessed at the New York State Worker s Compensation Website: http://www.wcb.ny.gov/. You will then select Forms and then under the heading Disability Benefit Forms (Off the Job Injuries), select Employees. Once this page opens, select form DB-450. Online Advantage users may access all their policy specific forms from their Online Advantage account under "Documents and Reports", choose "policy forms." Instructions for filing a state disability claim: 1) There are two sections of this form that will need to be completed. They are as follows: Claimant Statement Part A. The questions contained in this section go over basic employee information, questions regarding the disability, income from other sources and physician information. This section will need to be completed by the employee. Health Care Provider Statement Part B. This will need to be completed by the employee s Health Care Provider. This section includes detailed questions regarding the disability. Please forward all pages of claim form to Assurant Employee Benefits at one time. This will help to speed up the processing of the claim. 2) Claims can be mailed or faxed: Assurant Employee Benefits Fax: 866.439.1695 Disability Claims PO Box 419244 Kansas City, MO 64141-6244 Email: disabilityclaimonlinesubmissions@assurant.com 3) Our Claims Department can also be contacted at 877.829.6791. Note: The employee should also complete the DISABILITY-HIPAA Authorization for Release of Health Information. This will be necessary for us to obtain any further medical data to determine claim eligibility. If this is not completed, processing of the long-term disability claim can be delayed. Note: If either you or your employee has any questions, please refer to the New York Sate Workmen s Compensation website: http://www.wcb.state.ny.us/. 21
Vision Claim Instructions Submitting Claims with a VSP Network Doctor: The doctor will submit the claim for the patient. 1) When patients contact a VSP doctor to make their appointment, they must tell the office that they have VSP. The office will then obtain a benefit authorization from VSP. 2) VSP will send the benefit authorization which will include the following information for the doctor: a. The available services for that patient and the next availability date for any service for which they are not currently eligible, b. Copay amounts, c. Frame allowance, d. Contact lens allowance, and e. Special plan handling information. 3) When patients use a VSP doctor, the doctor will use the benefit authorization to bill the VSP for the services rendered. 4) Patients are responsible to pay only the copays and plan overages. Submitting Open Access Claims (a doctor that does not participate in the VSP network) When non-vsp preferred providers are sued, members submit their claims for reimbursement. 1) The patient pays for the services in full at the time of service from the open access provider. 2) The patient completes an open access claim form, which can be accessed by logging into www.vsp.com. 3) The patient sends the itemized receipt and completed claim form to VSP for reimbursement up to the plan allowances. If the patient does not have access to a computer, the itemized receipt can be mailed to VSP along with the following information: i. Member s name and ID number/social security number ii. Patient s name and date of birth iii. Member s mailing address and phone number. If you need to contact VSP with any questions, they can be reached on the web at vsp.com or via their toll-free number at 800.877.7195. 22
Billing Schedule Date Bill is Mailed Billing Date Bill Due Date Bill Grace Period Ends December 21 January 1 January 1 January 31 Note: The above assumes a billing date of January 1, in most instances your bill is mailed 10 days prior to the billing date / due date. Please see your first statement for your specific schedule. Additional Notes: 1) You may view your bills and make changes online at www.assurantemployeebenefits.com using Online Advantage for Employers. As a registered user of Online Advantage you will receive an email alert 5 days before your bill is created for you to make changes. You will also receive an email alert that your bill is ready to view and can make changes and regenerate your bill for 10 days. 2) Please pay as billed. Changes made via Online Advantage, email, fax, phone or mail after you have received your bill will appear on in the adjustment section of your next premium statement. 3) Please refer to the front page of your billing statement for remittance address. 4) If you have any questions on your billing statement, you may contact Assurant Employee Benefits Customer Advocacy at 888.901.6377. 5) If you would like to discontinue the generation of a paper bill, please contact Assurant Employee Benefits Customer Advocacy at 888.901.6377. 23
Mobile Apps Benefit Tools Eddy Woodward Team Specialist Connect. Search. Find. Benefit Tools App Get benefits information on the go! Use this app to quickly access: My Benefits An overview of all your coverage details ID Card Your electronic dental ID card Find A Dentist Uses your location to find a dentist nearby Find An Eye Doctor - Uses your location to find an eye doctor nearby Contact Us Connect with us to ask questions Individual Dental Plans Learn about the products we sell in your area This secure app is available for iphone, ipod Touch and Android. Assurant Employee Benefits is the brand name for insurance products underwritten by Union Security Insurance Company and for prepaid products provided by affiliated prepaid dental companies. In New York, insurance products are underwritten and prepaid products are provided by Union Security Life Insurance Company of New York, which is licensed solely in NY and has its principal place of business in Syracuse, NY. Assurant 2010 KC4780-J (5/2013) 24
Online Advantage for Members Quick. Smart. Convenient. Online Advantage for Members Is it important for you to be able to manage your dental and/or vision care online, on your schedule? If the answer is yes, we are confident Online Advantage is the right tool for you. What is Online Advantage? Online Advantage is a tool that allows you immediate access to your plan information. We built Online Advantage for you, our user. It gives you the power to view your benefits and claims on your terms, at your convenience at no additional charge. Easy Registration Sign up today! 1 Go to www.assurantemployeebenefits.com 2 Click Register Now 3 All you need to register is your Member ID* and date of birth *Your member ID may be your social security number. Briana Lewis Customer Advocacy, Team Lead Assurant Employee Benefits is the brand name for insurance products underwritten by Union Security Insurance Company and for prepaid products provided by affiliated prepaid dental companies. In New York, insurance products are underwritten and prepaid products are provided by Union Security Life Insurance Company of New York, which is licensed solely in NY and has its principal place of business in Syracuse, NY. Plans contain limitations, exclusions and restrictions. Contact us for costs and complete details. 25
Online Advantage for Members How can Online Advantage help you? You can: View and/or print personalized dental ID cards View and/or print benefit information pages (all benefits) View most recent dental visits and procedures View and/or print booklets View status of submitted claims Find a vision or dental network provider and/or specialist Access our Dental Health Center where you can ask a question, estimate the cost of service or learn about dental issues Questions? We provide online support with a friendly, dedicated team willing to assist you online or by phone. Give Online Advantage a try, register today! For more information or to register by phone call 800.733.7879 extension 7600. 2323 Grand Blvd. Kansas City, MO 64108 www.assurantemployeebenefits.com Assurant 2009 KC4545A-J (8/2015) 26
Online Advantage for Employers Quick. Smart. Convenient. Online Advantage for Employers Is it important for you to be able to access policy information, view your billing statements, and make changes to your account online? If the answer is yes, we are confident Online Advantage is the right tool for you. What is Online Advantage? Online Advantage is a tool that allows you to manage your policy online in real-time. We built Online Advantage for you, our user. It gives you the power to manage your policy on your terms, at your convenience. And, because we want you to use Online Advantage for the accuracy and efficiency it can provide, there s no additional charge for this service. Easy Registration Sign up today! 1 2 3 Go to www.assurantemployeebenefits.com Click Register Now All you need to register is your policy number. Gagan Bhatia Test Engineer Assurant Employee Benefits is the brand name for insurance products underwritten by Union Security Insurance Company and for prepaid products provided by affiliated prepaid dental companies. In New York, insurance products are underwritten and prepaid products are provided by Union Security Life Insurance Company of New York, which is licensed solely in NY and has its principal place of business in Syracuse, NY. Plans contain limitations, exclusions and restrictions. Contact us for costs and complete details. 27
Online Advantage for Employers How can Online Advantage help you? You can: Upload and compare census to easily identify differences for quick enrollments, terminations, and changes Access and update policy information at your convenience with the end result being an accurate on time bill every month View bills as far back as 36 months to help you track your account history Download member details to Excel to help with reporting By providing: Bill regeneration a smart feature providing an easier way to generate a bill the same day Automated confirmation of every transaction and reminder emails to help record keeping and billing accuracy Online support with a friendly, dedicated team willing to assist you online or by phone Give Online Advantage a try, register today! For more information or to register by phone call 800.733.7879 extension 7600. 28
Customer Advocacy Contact Sheet Customer Advocacy Contacts At Assurant Employee Benefits, we strive to continually make it easier for you to do business with us. If you are looking for an enhanced customer experience for you and your customers we are the answer. At the center of this program is our Customer Advocacy Team. This team boasts an average staff tenure of over 10 years and a senior management tenure of over 12 years. The home office Customer Advocacy team is nearly 350 people strong so there is always someone available to help. What does Customer Advocacy provide? New case installation and amendment processing Customer service and ongoing case maintenance Initial and ongoing billing Premium collections Licensing and commissions Electronic eligibility exchange Prepaid provider services Individual prepaid support Online Advantage Life/LTD conversions What does this mean for you and your customers? A single point of contact and accountability A consistent customer experience A subject matter expert on your cases What should you send directly to your Customer Advocacy team? Administration questions and status requests Immediate administration needs (ie. enrollment forms, terminations, salary changes, COBRA) Employee life status and beneficiary changes Billing adjustments and premium payment questions Evidence of insurability questions Waiver of premium for LTD, STD and Life coverages Requests for forms and supplies In New York, insurance products are underwritten and prepaid products are provided by Union Security Life Insurance Company of New York, which is licensed solely in NY, has its principal place of business in Fayetteville, NY, and is solely responsible for the financial obligations of its policies. Plans contain limitations, exclusions, reductions and restrictions. Benefits provided and premium amounts depend upon the plan selected. Contact us for costs and complete details. 29
Customer Advocacy Contact Sheet Customer Advocacy Contacts General customer service Employee enrollments, terminations and salary changes COBRA enrollments/terminations Billing inquiries Eligibility and enrollment questions Booklets T 888.901.6377 (7 a.m. - 7 p.m. M-TH CST; 7 a.m. - 6 p.m. Fri CST) F 888.208.2323 customeradvocacy@assurant.com Assurant Administrative Office P.O. Box 981624 El Paso, TX 79998-1624 Premium payments Always remit premium payments to the address on your premium statement, and include your statement or remittance stub when making payments. If for some reason you do not have a statement, please contact us at 888.901.6377. Online Advantage All transactions assurantemployeebenefits.com onlineadvantage@assurant.com 800.733.7879 ext.7600 Electronic Commerce (Ecomm) Contact us if you need help establishing Ecomm (a/k/a electronic data exchange) for policy or claims administration. We can work with most group sizes and most coverages. All transactions techspecialistefeeds@assurant.com 800.456.9194 Portability/Conversion Contact us if you have an employee that needs help with porting or converting their plan after terminating coverage. All transactions individualteam@assurant.com 866.909.6065 Broker Services All licensing and commission inquiries Claims services.brokers@assurant.com 888.901.6377 ext. 3970 (Commissions) 888.901.6377 ext. 3971 (Licensing) Dental Indemnity 888.901.6377 dentalclaims@assurant.com Dental Prepaid 888.901.6377 dentalclaims@assurant.com Life 888.901.6377 lifeclaims@assurant.com Disability 888.901.6377 disabilityclaimonlinesubmissions@assurant.com Forms and supplies are available on our website, www.assurantemployeebenefits.com or by calling us at 888.901.6377. 2010 Assurant KC3253NY (1/2014) 30
Who Should I contact? Dedicated Customer Advocacy Team Eligibility Questions/Changes Contract Questions Billing Questions/Changes Rate Calculations Proof of Good Health Status/Questions Employee Benefit Advisor Sales Office Interest in New Coverages Coordinated through Broker Renewal Questions Enrollment Meetings/Benefit Fairs Enrollment Material Contract Amendments 31