Humana Small Business Agent Sales Guide

Transcription

1 Humana Small Business Agent Sales Guide GN HH 2/09

2 Table of contents Guaranteed access Employer eligibility Employee eligibility... 2 Dependent eligibility... 2 Quote requests... 3 Be a step ahead with Easy Rate online... 3 Other methods to obtain a quote Information you ll need to quote companies of Multiple business locations Enrollment requirements... 4 Participation requirements Retirees... 4 Effective dates... 5 Humana online account management... 5 Excluding a location... 5 Humana online account management... 5 Contribution requirements Medical, basic life, and AD&D... 5 Dental... 5 Vision... 5 Short-Term Disabilit/Long-Term Disability... 5 Multiple-choice requirements Medical products for companies of Dental products for companies of 10 or more employees Vision... 6 Prescription drug products for companies of 2 or more employees... 7 Short-Term Disability/Long-Term Disability... 7 Leasing companies... 7 Leased employees... 7 Leasing companies/professional Employer Organizations (PEOs)... 7 Companies using the services of an employee leasing company/peo... 7 Companies breaking away from their leasing/peo arrangements... 7 Adding a line of coverage... 8 Small business plan change process Specialty benefits plan change process Contact information Business groups of one Any location in this guide that lists the minimum eligible enrolled employee count as two must be modified in the following markets: Colorado Florida North Carolina In these markets, Humana allows business groups of one to enroll for coverage. To qualify as a business group of one (BGO), the individual, sole proprietor, or single full-time employee must derive at least a substantial amount of his or her income for one year out of the most recent consecutive three-year period. A substantial part of an individual's income means an amount sufficient to pay the annual insurance premiums of the BGO. These guidelines will assist you in obtaining quotes for and enrolling your fully insured companies of 2 to 99 active employees. For specific questions or additional information, please contact your Humana sales executive. This guide is subject to change. Contractual information supersedes information in this guide.

3 Guaranteed access An employer of 2-50 eligible employees that meets underwriting eligibility and participation requirements is guaranteed access to all available small business medical products. Determination of case size includes all of the following: All full-time employees working 30 or more hours per week for the employer are eligible (may be reduced to a minimum of 20 hours per week) All employees of any commonly held companies who are eligible to file a combined tax return, regardless of which companies are to be included for coverage All employees in excluded classes All employees waiving coverage All employees currently within their probationary waiting periods We will not count seasonal employees unless they are considered eligible by the employer and meet Humana s eligibility guidelines. Employer eligibility Must be able to verify an employer/employee relationship Group participation levels and employee eligibility must be verifiable through company records When the only employees of a two-life company are husband and wife, each must enroll separately as an employee; eligible dependents can be covered under either employee Humana must be the exclusive health plan provider for employers with 2-99 eligible employees There must be at least one employee on the state Wage and Tax Employee eligibility: This is a general definition. Employee means a person who is: Working in an active status at the employer s place of business, and Paid a salary or a wage by the employer that meets state or federal minimum wage laws Active status means the employee is performing all of his or her customary duties: 1. On a regular basis For the required hours per week shown on the Employer Group Application For at least 48 weeks per year While maintaining an employer/employee relationship with the sponsor of this group policy on a regular basis If an employee was in an active status on his or her last regular working day before a vacation or holiday, each day of the regular vacation or holiday is deemed active status Call your local sales office for eligibility of U.S. citizens working in a foreign country Foreign employees legally working in the United States may be eligible Dependent eligibility: Dependents are defined as an employee s legal spouse and unmarried natural-born children, stepchildren, legally adopted children, or court-appointed legal guardians. Call your local sales office for dependent eligibility guidelines for your state 2 Humana Small Business Agent Sales Guide

4 Quote requests Be a step ahead with Easy Rate online Get your quote online when you need it at Humana.com. You can create a single-location quote from your computer for companies of 2-50 employees enrolling for medical, dental, vision, life, and STD and LTD coverage. Contact your local sales office or Easy Rate for medical, dental, vision, life, and STD and LTD quotes for groups of eligible employees. Other methods to obtain a quote: Call Easy Rate at or Fax to or ezrate@humana.com Information you ll need to quote companies of 2-99 eligible employees: Name, address and phone number of employer Nature of business and standard industry code (SIC) Name of prior carrier (medical and dental) Requested effective date Information for each eligible employee: gender, age or birth date, and coverage type (single, family, employee with child, employee with spouse, and waivers) Medical information (if Express Underwriting, see Express Underwriting form) Requested plan(s): Provide specific names of products you want quoted Salary data if requesting a salary plan for Life products or any STD/LTD products Agent tax identification or Social Security number Fax number, address, or address for quote delivery 24-hour coverage available for owners, officers and partners. (Not applicable in Texas) For companies of 2-50 enrolled employees, basic life and AD&D coverage are required with the sale of medical for the following states: Arkansas, Colorado, Indiana, Michigan and Missouri For companies of 20 or more employees, Short-Term Disability (STD), Long-Term Disability (LTD) and Workplace Voluntary Benefits may be available Multiple business locations For companies of 2-99 eligible employees enrolling for coverage: If quoting a company with more than one business location, separate the above information by location. A separate billing fee for each location may apply 3 Humana Small Business Agent Sales Guide

5 Enrollment requirements The following information is required when submitting enrollment applications for companies of 2-99 eligible employees enrolling for coverage: Employer Group Application Employee enrollment forms with medical information based on case size An application or waiver form must be requested for any individual within his/her continuation election period Waiver forms must be completed and submitted for employees not electing coverage for themselves or their eligible dependents Waiver forms are not required for voluntary dental coverage; in lieu of waiver forms, the employer must submit a letter stating all eligible employees had the opportunity to enroll Copy of quote or proposal presented to the employer First month s premium deposit check (from employer s account, payable to Humana) or ACH form for automatic withdrawal Additional medical information requested by Underwriting Certificate of Prior Coverage form for any applicant with prior creditable health coverage Copy of current carrier s most recent billing statement Single case agreement, if applicable (applies to companies of 25 or more enrolled lives) Signed and dated Rating and Renewability Disclosure (for Wisconsin only). The Wisconsin Rating and Renewability form must be signed before signing the Employer Group Application and must be received with the new case submission. Eligibility Certification Form for employees not listed on the state Wage and Tax Full-time Employment Questionnaire for contracted or commissioned employees who meet the definition of eligible employee Copy of employer s most recent quarterly state Wage and Tax Humana requires health status information to be collected when submitting an application for new coverage. Refer to the state-specific employee enrollment form for the rules for your market. The most up-to-date enrollment forms can be found on Humana.com. Incomplete submissions may delay processing of the group s application. Humana cannot approve coverage until all completed enrollment requirements are met. Note: In Utah, a one-time surcharge equal to 25 percent of annual premium will be assessed to any max-rated small business that is moving off its annual anniversary date. Participation requirements Participation requirements vary based on issuing state. Please refer to the state-specific Employer Group Application. Retirees Medical or dental retiree coverage is an option available for companies of 26 or more active employees enrolling for coverage. The minimum age for retiree eligibility is 65 Case size determination count does not include retired employees or former employees who are on continuation The percentage of retirees cannot exceed 10 percent of the entire enrollment per line of coverage Retirees are not eligible for basic life or AD&D coverage Retirees are not eligible for LTD or STD coverage 4 Humana Small Business Agent Sales Guide

6 Effective dates First of the month effective dates are our standard practice Sold case materials must be received in your local sales office no later than five days after the requested effective date* All applications must be signed and dated before the requested effective date. Humana s Underwriting department reserves the right to determine the effective date Notify Underwriting of any change in health status or eligibility while a case is pending It is important that you advise your client not to cancel any current group coverage until written approval is received from Underwriting. Humana online account management Humana s Website makes account management a snap. Log on to the Agent Self-Service Center at Humana.com or HumanaDental.com to see a listing of your accounts. Depending on case size, quoted accounts will remain viewable online for up to six months. E-enrollment tools (for accounts in states approved for e-enrollment) and quoting tools are available in the Quote, Enroll, & Manage section of the agent portal. You can organize and sort your accounts, as well as attach notes to the cases for your reference or Humana s. Excluding a location In Florida, companies of 2-50 eligible employees must have filed a separate federal income tax return for each entity or business location they wish to exclude from coverage For companies of eligible employees, the employer group has the option to exclude any entity or business location Contribution requirements Medical, basic life, and AD&D Employers must contribute a minimum of 50 percent of the employee cost for medical, basic life, and AD&D coverage. Basic dependent life and voluntary life coverage are exempt from this requirement. For companies of 2-3 employees, the employer is required to contribute 100 percent of the employee premium and 80 percent of the dependent premium. (for Florida only) Dental Employers must contribute a minimum of 25 percent of the employee cost for employer-sponsored dental coverage. The employer can contribute to the employee cost of voluntary dental plans; however, it is not a requirement. Vision Employers must contribute a minimum of 75 percent of the employee cost for employer-sponsored vision coverage. The employer can contribute to the employee cost of voluntary vision plans; however, it is not a requirement. Short-Term Disability/Long-Term Disability (STD/LTD) Employers must contribute 100 percent of the employee cost for STD and LTD. 5 Humana Small Business Agent Sales Guide * Florida 2-3 enrolled employee groups must be received in your local sales office 60 days before the requested effective date (Central Florida based on eligible count).

7 Multiple-choice requirements Multiple-choice arrangements allow an employer to offer more than one Humana medical or dental plan to employees. Medical products for companies of 5-99 enrolled lives: Up to two medical plans per group are allowed Three medical plans may be allowed on 26+ groups if offering a High Deductible Health Plan (with or without a Health Savings Account) or a Personal Care Account. Confirm options with your sales executive Medical plans must have the option of being offered together Optional buy-up benefits must be the same for all plans offered For 5-9 enrollees, total premium may not differ by more than 17 percent between the highest and lowest cost plan. For enrollees, total premium may not differ by more than 30 percent between the highest and lowest cost plan.* To arrive at the difference, divide the total monthly premium of the lowest cost medical plan by the total monthly premium of the highest cost medical plan Include premium for all options and riders selected, including drug benefit, in calculation Include the entire census of the group when calculating the total premium for each plan Employees can change from one plan option to another on the plan s anniversary date only Dependents are not allowed to select different options than the employee Normal participation guidelines apply Multiple choice is available based on the following requirements: Enrolled State 2+ lives Texas 5+ lives Arizona, Arkansas, Colorado, Florida, Georgia, Illinois, Indiana, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Ohio, Tennessee, Wisconsin 10+ lives Alabama, California, Nebraska, Nevada, North Carolina, Oklahoma, South Carolina, Virginia Dental products for companies of 10 or more employees: Up to two dental plans per group are allowed There is no minimum enrollment per plan as long as standard group participation guidelines are met** Orthodontia options must be selected on both products or not at all, with exceptions on the Preventive Plus and DHMO/Prepaid plans Optional orthodontia is available on 10+ enrolled groups for children up to age 19 Orthodontia lifetime maximums do not need to be the same on both plans Multiple-choice is available within the same product choice (two PPO plans) Multiple-choice is not available within the same plan (i.e., same plan with different deductibles) Multiple-choice dental plans must be either voluntary or employer-sponsored, not a combination of both Adding or deleting a dental plan to create or discontinue a multiple-choice arrangement is allowed at renewal Employees can change from one plan option to another on the plan s anniversary only Vision Dual-choice arrangements are not allowed for any size vision groups. 6 * Colorado allows a 20% premium differential, Florida a 40% premium differential, and Texas allows a 30% premium differential. Humana Small Business Agent Sales Guide ** Minimum enrollment may apply to DHMO plans.

8 Multiple-choice requirements (continued) Prescription drug products for companies of 2 or more employees: Multiple-choice of Rx4 and RxImpact drug plans is allowed subject to the following*: In dual-choice situations, RxImpact must be coupled with the lower cost medical plan of the two plans being offered. In triple-choice situations, only two Rx plans can be offered. RxImpact must be coupled with the lowest cost plan of the three plans being offered. The same Rx4 option must be coupled with both buy-up medical plans being offered. STD/LTD Multiple-choice arrangements are not allowed on STD and LTD products Leasing companies Leased employees: Leased employees are the employees who are employed by the leasing company (Company A) but work at a separate employer (Company B) Leased employees may be eligible for coverage if they meet the criteria of a full-time employee, and the group meets the eligibility and participation requirements Leased employees eligibility is not determined by which company pays the wages / salary Leasing companies/professional Employer Organizations (PEOs): Leasing companies are companies (Company A) that lease their employees to another company (Company B) Leasing companies (Company A) of 51 or more full-time employees on their state Wage and Tax are not eligible for coverage based on the nature of the industry Any other company is underwritten as usual regardless of whether any or all of the employees are leased from a leasing company Leasing companies (Company A) of 2-50 full-time employees are subject to all eligibility and participation requirements Groups of 100 percent leased employees (Company B) may be eligible, subject to meeting all eligibility requirements Companies using the services of an employee leasing company/peo The following eligibility requirements must be provided: Current state Wage and Tax Eligibility Certification Form for the employees not on the state Wage and Tax Detailed bill for leased employees from leasing company (Company A) Prior carrier insurance bill Initial premium checks must come from the employer (Company A) even if a Professional Employer Organization (PEO) is administering the payroll and benefit plan for the employer (Company B) Companies breaking away from their leasing/peo arrangements ALL of the following documents are required from the company applying for insurance (Company B), not the leasing/peo; Authoritative documentation (a written explanation as to the specifics why a group is exempt from filing a state Wage and Tax with reference to the specific law this is based on) Documentation of employer identification number A completed Eligibility Certification Form Current W-4 forms** 7 Humana Small Business Agent Sales Guide * When only one medical plan is offered to a group, only one prescription plan can be offered. ** The employer identification number should be referenced on the W-4.

9 Adding a line of coverage Scenario* Documentation needed Process Adding medical coverage Adding dental coverage Adding basic life coverage Adding voluntary life coverage Adding vision coverage Adding a HSA (HDHP is required) Enrollment forms and waivers Groups under 50 require state Wage and Tax Copy of current billing statement if group had a prior carrier Gatekeeper questions, Evidence of Health Status, or Risk Assessment Form (varies by group size and state) Disclosure for Consumer Choice NPOS form (only if group is in Texas and adding an NPOS product) Enrollment forms and waivers or list enrollment Prior carrier information Enrollment forms and waivers or list enrollment Evidence of Health Status if over the guarantee issue amount Enrollment forms or list enrollment Evidence of Health Status if over the guarantee issue amount Enrollment forms or list enrollment Enrollment forms Agent submits documentation to the sales office Sales reviews paperwork and obtains any missing documentation before submitting it to the appropriate area for processing Medical and life over guarantee issue need to be approved by Underwriting 8 Humana Small Business Agent Sales Guide * The chart shows common scenarios and is not all inclusive. Contact Billing and Enrollment at for additional information.

10 Small business plan change process Scenario* Documentation needed Process Changing from one single option product to another single option product on renewal** Changing from one single option product to another single option product off renewal** Changing from a single or multiple option to multiple options** Changing life volume amount Changing life volume from single/ flat amount to a class schedule Changing life volume amount to an amount above the guaranteed issue amount Request for group split (spin off) Online broker account maintenance request Adding a working location if reduction in premium and not within 90 days of group s renewal Enrollment forms or a listing of members and their plan selections Listing of members, their class, and amount Listing of members, their class (if applicable) and amounts. Evidence of Health Status Enrollment forms or listings of members Account Maintenance Request (online submission) If NPOS in Texas, need NPOS Disclaimer form Multilocation Form (if issue state is changed or added) Enrollment forms for new location members plan change to beclericals@humana.com or faxes to The Plan Change team processes the plan change plan change to beclericals@humana.com or faxes to The Plan Change team forwards to Underwriting for approval The plan change team processes after approval is received plan change to beclericals@humana.com or faxes to The Plan Change team processes Agent submits Account Maintenance Request via Humana.com The Plan Change team processes the plan change The NPOS Disclosure form would need to be faxed or ed plan change to beclericals@humana.com or faxes to The Plan Change team processes the added location 9 * The chart shows common scenarios and is not all inclusive. Contact Billing and Enrollment at Humana Small Business Agent Sales Guide for additional information. ** Changing to or adding a National Point of Service (NPOS) product in Texas requires the Disclosure for Choice NPOS form

11 Specialty benefits plan change process Scenario* Documentation needed Process Changing from one single-option product to another single-option product on renewal Changing from one single-option product to another single-option product off renewal if reduction in premium. Also, this process cannot be completed within 90 days of the group s renewal Changing from a single-option plan to a multiple-option plan Changing life volume amount Changing life volume from single/ flat amount to a class schedule Changing life volume amount to an amount above the guaranteed issue amount Request for group split (spin off) Adding a working location if reduction in premium and not within 90 days of group s renewal Enrollment forms or a listing of members and their plan selections EOIs if over guarantee issue amount Approval from Underwriting EOIs if over guarantee issue amount Listing of members, their class (if applicable), and amounts. Evidence of Health Status List of employees transferring to new group amounts Enrollment forms for new employees Multilocation form if new location is going to have state-specific benefits (Employer Group Application for each working location being added) Enrollment forms for new location members plan change to dentalplanchangeteam@humana.com or faxes to The Plan Change team processes the plan change. plan change to dentalplanchangeteam@humana.com or faxes to The Plan Change team forwards to Underwriting for approval The plan change team processes after approval is received plan change to dentalplanchangeteam@humana.com or faxes to The Plan Change team will process plan change to dentalplanchangeteam@humana.com or faxes to The Plan Change team processes the added location 10 Humana Small Business Agent Sales Guide * The chart shows common scenarios and is not all inclusive. Contact Billing and Enrollment at for additional information.

12 Contact information Contact information Easy Rate Phone: Fax: ezrate@humana.com Conservation Phone: Fax: conservation@humana.com Billing and Enrollment Phone: Employee and employer adds/terms/changes Fax: Employer plan changes Fax: beclericals@humana.com (plan changes only) Commissions/Licensing Phone: , ext Fax: agencymgt@humana.com Ceridian (Premium Only Plans) Phone: Fax: Ceridian (COBRA Administration) Phone (members): Phone (employers): Fax: State Continuation Fax: continuation@humana.com Agent/Member Web assist Phone: , ext Employer Web assist: , ext SPAA (Spending Accounts Administration) Phone: Broker Team: Phone (agent): ASSIST Phone (agent or broker): Claims and Benefits HMO business: All other business: Fax: Claims - Medical Claims Department Humana Claims Office PO Box Lexington, KY Pharmacy Claims/Receipts Fax: Claims - Pharmacy Humana Attn: Pharmacy Operations 1100 Employers Blvd Green Bay, WI Claims - Dental HumanaDental Claims PO Box Lexington, KY Claims correspondence PO Box Lexington, KY Grievance and Appeals PO Box Lexington, KY Humana Small Business Agent Sales Guide

13 Humana.com Humana Plans are offered by the Family of Insurance and Health Plan Companies including Humana Medical Plan, Inc., Humana Employers Health Plan of Georgia, Inc., Humana Health Plan, Inc., Humana Health Benefit Plan of Louisiana, Inc., Humana Health Plans of Michigan, Inc., Humana Health Plan of Ohio, Inc., Humana Health Plans of Puerto Rico, Inc., License # , Humana Wisconsin Health Organization Insurance Corporation, Humana Health Plan of Texas, Inc. A Health Maintenance Organization, The Dental Concern, Inc. or The Dental Concern, LTD, 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, Emphesys Insurance Company, Humana Insurance of Puerto Rico, Inc. License # or HumanaDental Insurance Company, or administered by Humana Insurance Company or HumanaDental Insurance Company. For Arizona Residents: Offered by Humana Health Plan, Inc. or insured or administered by Humana Insurance Company, Emphesys Insurance Company or HumanaDental Insurance Company Our Health Benefit plans have limitations and exclusions. GN HH 2/09