Services and Fees COBRA Continuation Coverage

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1 Services and Fees COBRA Continuation Coverage

2 Introduction WageWorks, Inc. is pleased to present a proposal to Administer COBRA Continuation Coverage. This section outlines our services and fees for implementing and administering COBRA. The Consolidated Omnibus Budget Reconciliation Act of 1985 (P.L ) requires employers of 20 or more employees to continue health care coverage for terminated employees and for surviving spouses, ex-spouses and dependents of employees. The administrative burden of this requirement can be overwhelming. Proper notices, coupled with exact timing and tedious recordkeeping make this a perfect opportunity for outsourcing. Not only are initial notice requirements critical but the actual timing and contents of the notices are also crucial in compliance efforts. Failure to comply with COBRA requirements can result in substantial penalties and fines. We enjoy working with our clients and take a personal interest in assisting organizations in meeting their business goals. WageWorks believes this attitude is exemplified in our enthusiasm and by our strong, enduring client relationships across the United States. Please contact us with your questions or to request client references. Page 2 of 5

3 Cobra Administrative Services There are three phases to providing administrative services: the initial start-up, ongoing maintenance, and open enrollment. Phase I Start-Up In Phase I, we provide project deliverables such as communication materials, enrollment materials, and administrative guides. Project Deliverables Client Administrative Guides. These guides are provided to detail the implementation process and on-going administrative services. COBRA Communication and Enrollment Materials. The communication materials are established in compliance with COBRA regulations. They are designed to help employees and potential COBRA participants to understand the complex rules established under COBRA. Data Import. Uploading data into our administrative system is the primary method of receiving information. Page 3 of 5

4 Cobra Administrative Services (continued) Phase II Ongoing Maintenance Phase II involves the program s ongoing administration. COBRA Administration includes several functions, which are performed by the client, COBRA qualified beneficiary or by WageWorks. Following is the flow of activity: DOL Initial General Notice. WageWorks prepares and sends the Initial General Notice to all employees and spouses who become covered for a COBRA eligible benefit after WageWorks begins administration. Qualifying Event Process. Clients have 30 days in which to notify WageWorks of an employee s death, termination of employment, reduction of hours or employer s bankruptcy. Employees have 60 days to notify the plan administrator (employer) of a divorce or legal separation, a dependent child ceasing to meet the plan s eligibility requirements for a dependent child. WageWorks has 14 days from the date of notification to provide notification of COBRA rights to qualified beneficiaries, via first class mail, to the last known address for the beneficiary. COBRA Enrollment. Beneficiaries have 60 days to elect COBRA continuation coverage and notify WageWorks of the election. Medicare Part D Notice. WageWorks sends the applicable model notices to the COBRA Continuees who are (or are about to become) eligible for Medicare. This notice is automatically sent for the health plans that have been designated as Creditable for purposes of Medicare Part D. COBRA Payments. Premiums for periods preceding the election must be remitted during the next 45 days. Beneficiaries have 30 days in which to make each subsequent COBRA payment. This premium can be any amount determined by the client, up to 102 percent of the plan s cost for other similarly situated employees. When a beneficiary extends COBRA continuation due to a disability determination made by Social Security, the premium can be any amount determined by the client, up to 150 percent of the plan s cost for other similarly situated employees. Client and Carrier Communications. WageWorks will communicate with the carrier and/or TPA to make sure that COBRA eligibility is properly reflected. In addition, COBRA premiums sent to the COBRA administrator will be reported to the client for inclusion with the carrier s payment. Phase III Open Enrollment Open Enrollment. During the active employees re-enrollment or open enrollment period, all COBRA beneficiaries must be allowed the same open enrollment choices as the active employees. In addition, COBRA beneficiaries are notified of renewal rates for the coming year. Page 4 of 5

5 Administrative Pricing Implementation & On-Going Initial Set-Up Fee (one time, non-refundable) Less than 5,000 employees $500 Greater than 5,000 employees $1,000 Monthly Fee Schedule The monthly administrative fee is based on the number of current continuants. Continuants Fee 1 to 499 $ to 999 $26 1,000 to 4,999 $20 5,000 to 9,999 $17 10,000+ or more $14 The monthly minimum is $100. 2% Administrative Fee Billed to enrolled qualified beneficiaries Premiums collected are remitted to the employer Retained by WageWorks DOL Initial General Notices Qualifying Event Letters Premium Billing and Collection HIPAA Certificates Medicare Part D Notices Related Service Fees Carrier Premium Remittance (Assessed only when WageWorks issues payments on behalf of client) Per carrier payment per month $50 Mailing of DOL Initial General Notices (Assessed if requested by client) Per notice $2.50 Open Enrollment Materials Fee (Assessed only when WageWorks issues open enrollment materials) Per COBRA beneficiary $11.00 Travel Expenses from Vista, CA If beyond a 50 mile radius from WageWorks Vista office Billed at cost Reports Standard Custom Incidental Expenses Printing, copying, postage for materials or non-standard mailings, retrieval of archived records, etc. Quoted per request Billed at cost Data interface in other than WageWorks format $1,500 Page 5 of 5