Small group medical underwriting FAQ

Transcription

1 Small group medical underwriting FAQ General Questions 1. What is medical underwriting for small businesses? Medical underwriting is a method of determining an employer s premium rate for health insurance based on the health of the businesses employees. When IBC begins offering medically underwritten health plans to new small business customers (2 to 50 employees) this year, we will ask that each employee at the business complete a medical questionnaire that summarizes the medical history over the last five years of the employee and each member of his/her family. 2. Why are you introducing medical underwriting now when health care reform will not allow it in 2014? Other health insurers in the Philadelphia market began offering medically underwritten coverage to small businesses in Since then, IBC has lost a significant number of customers as small employers with healthier employees left IBC for the lower, medically underwritten rates available through other health insurers. To remain a stable business, a health insurer needs a balance of good- and bad-risk customers. To keep our business stable, we can no longer afford to lose these healthy small business customers to our competitors. Offering medically underwritten plans for small businesses allows IBC to continue to serve our current customers. In 2014, the health insurance landscape will change dramatically when the Patient Protection and Affordable Care Act eliminates medical underwriting as a method for setting rates for health care plans. In 2014, the law requires that all health insurers accept every person and business that applies for health insurance, regardless of their health status. The law will only allow rates to vary based on gender and age. 3. What about the small businesses with older, less healthy employees? Where does this leave them? IBC covers many higher risk small employers since traditionally there has been no other alternative for them to get coverage except through us since That is when our competitors began medically underwriting small groups and offering unaffordable rates to small businesses whose employees were less healthy. Most of those businesses who had employees who were less healthy and needed coverage came to IBC and we continue to insure them. 4. What about IBC s existing small business customers, those who have been with IBC prior to this rating methodology change? Do they also get medically underwritten? No. Medical underwriting will not apply to our current customers, only to small business customers with 2 to 50 employees whom we do not currently cover. In January of this year, we adjusted the way we set rates for our current small business customers using five factors: age, gender, location, size, and past claims experience. This new rating methodology reduced rates for nearly half of our current small business customers during What kind of differential between the new medically underwritten quotes and IBC s previous quotes can small business customers expect to see? Generally, employers whose employees have used fewer health care services may be offered rates that will be as much as 30% lower than rates we previously offered. 6. How many small businesses will actually get the rate that is initially offered?

2 For about a third of small businesses that request a medically underwritten rate from IBC, the initial rate they are quoted will be the same as the final rate they will pay. 7. How far might a small business s final rate quote vary from the initial rate? The rate will vary depending on the information provided on the questionnaires and in some cases, may be as high as two or three times the initial quote. 8. What is the process through which brokers will submit questionnaires and IBC will respond with final quotes, on average, within three business days? When a small business expresses interest to its broker in a medically underwritten health plan from IBC, the broker provides IBC with age and gender information about the company s employees and requests a rate quote. We provide an initial quote, based on the employees demographic information without considering health status. Then the broker asks the business s employees to complete questionnaires about their medical histories over the last five years. Using this information, IBC s newly hired team of experienced underwriters and registered nurses review the questionnaires and if all questionnaires have been completed, give the broker a final quote within three business days on average. If the fully completed questionnaires are all submitted on a Monday afternoon, the broker can expect to get the final quote by Thursday afternoon, as long as there is no need to complete any Additional Information Request (AIR) forms (see question 18). If the fully completed questionnaires are all submitted on Friday morning, the broker can expect to get the final quote by Wednesday morning of the following week, as long as there are no AIRs. We are committed to providing a flawless streamlined process for you and your customers to promptly deliver competitive rates. 9. Will the paper medical questionnaires that employees complete be available in an electronic form in the future? We will work on ways to automate and further streamline the questionnaire process with guidance from our broker partners. However, protecting the confidentiality of prospective members personal medical information is a primary concern, and if we move to an electronic format, the process will ensure that members personal health information will be protected. 10. Do IBC s competitors offer only health plans that are medically underwritten for businesses? What about for individuals? All of our competitors in the marketplace only offer medically underwritten health plans to small businesses (2 to 50) and individuals. With the change we are announcing, IBC will now offer new small group customers these medically underwritten products and will be the only carrier to offer this market segment a medically underwritten HMO plan. In the meantime, IBC will continue to offer individuals guaranteed-issue plans available regardless of their health status plans which are not available from any other health insurer in our market. 11. Is the Pennsylvania Insurance Department aware of IBC s business decision to medically underwrite small group customers? Did they approve this rating methodology? We have reviewed our plans to medically underwrite small groups with the Pennsylvania Insurance Department (PID) and explained our proposed rating methodology in detail. As required, IBC filed the

3 rating methodology for the HMO plan with the PID. This was deemed approved by the PID. No filing was required for the commercial PPO product. 12. How will IBC s staff handle reviewing the paper medical questionnaires for each employee and dependent of every small group applying for medically underwritten coverage? We have created a brand new small group medical underwriting team of 20 experienced underwriters and registered nurses who will carefully evaluate each questionnaire and give the broker a final quote within three business days on average, if completed questionnaires are received. When questionnaires are incomplete and additional information is required, an underwriter will immediately request additional information through the electronic broker communication channel, ROAM. The three-day time clock does not start until all the information needed is provided to IBC. 13. What about the small group customers that are already IBC customers? Small group businesses that are already IBC customers will continue to get competitive rates when they renew their contracts. Beginning in January 2011, we changed our small group rates for renewing customers so that rates were based on five factors: age, gender, location, size, and past claims experience. We continue to use this pricing methodology for our current customers, and this year, 47% of customers with 10 to 50 employees got rate reductions, while 70% got new rates that were below medical cost trend (a measure of the increase in the costs of medical services for employers). 14. Is there a way I can contact someone in Underwriting? There is no direct way to contact Underwriting. If you have received an Urgent AIR (see question 19) form you should reply to the request using the electronic process provided for you in ROAM. If there is another issue or question separate from the AIR that you feel that Underwriting should be aware of, you should contact your account executive. Roam Quote Status 15. How can I tell the status of my quote? Use the Quote Search feature under the Quote tab to retrieve the quote. The Quote List includes a value in the Status column for each search result in the list. 16. I am a producing broker. Will I be notified when my primary has submitted my quote to Underwriting? Yes, producing agents will receive notification when their primary has submitted their quote to Underwriting. To guarantee that you will receive this , please check with your primary to confirm that they have your correct address on file. 17. What is the difference between the status Submitted to UW and UW Review? Submitted to UW means that the quote has been received by Underwriting and is awaiting assignment to an underwriter. UW Review means that the quote has been assigned to an Underwriter and the rating process has begun. Additional Information Request (AIR) 18. What is an AIR? AIR is an acronym for Additional Information Request. An AIR provides the recipient with information regarding the quote and may not require a reply response for the quote to proceed.

4 19. What is an Urgent AIR? An Urgent Additional Information Request (AIR) is an electronic message sent from Underwriting. The request requires a response on the part of the General Agent. The rate process for a submitted quote will be suspended until Underwriting receives a response to the Urgent AIR with the information requested. 20. What is the difference between an Urgent Additional Information Request and an Additional Information Request? An Urgent AIR requires a response by the recipient, and the rating process is suspended until Underwriting receives the response. An AIR is a message from Underwriting. It may require information to be sent by fax or other means, but does not allow an electronic reply response. 21. I received an AIR for a customer. How can I tell which producing broker owns the quote it was for? Use the Quote Search feature under the Quote tab to retrieve the quote. When the quote list displays, select the radio button to the left of the desired quote record and then click on the Display Quote option on the left hand menu of the screen. The Producing Agency and Preparer display on the quote screen under the Customer Information section. 22. How can I tell if Underwriting got my response to the AIR that I sent? You should check the status of the AIR. The status is displayed in the AIR list or in the body of the AIR. When you have responded to an Urgent AIR it will have the status of Responded. This will indicate that your response has been sent to Underwriting. 23. How do I view an AIR? Use the Quote Search feature under the Quote tab to retrieve the quote. When the quote list displays, select the radio button to the left of the desired quote record and then click on the Additional Information Request option on the left hand menu of the screen. A list of AIRs associated with the quote will display and additional request information can be accessed by clicking the Details link on the lefthand menu. 24. Can my producing agent reply to an Urgent AIR? No, only the General Agent has the ability to respond to an Urgent AIR. 25. Can my account executive reply to an Urgent AIR? No, only the General Agent has the ability to respond to an Urgent AIR. 26. Can my producing agent view the Urgent AIR that was sent? Yes, producing agents can view an Urgent AIR, but they cannot respond to it. 27. I just responded to an Urgent AIR, why is the status still open? Only Urgent AIRs can have an Open or Closed status. When Underwriting opens an Urgent AIR they are requesting additional information from the broker that is required for Underwriting to completely process the quotes. The response may also require the broker to fax additional material to Underwriting. Only Underwriting has the capability to close an Urgent AIR. Just responding to the Urgent AIR will not change the status to Closed. Underwriting will close the AIR once they have reviewed the response and/or the additional requested material. The status of the AIR will change to Responded when the broker sends the response.

5 28. I received an Information AIR and I do not see any place that I can respond to it. Is there a way I can respond to this? An Information AIR contains information from Underwriting regarding the submitted quote and does not require an electronic response. 29. I was told that I was supposed to be receiving s when an AIR has been sent for one of my quotes. Why am I not receiving any of these s? Response to Primary Broker: Please check with the person in your office that has ROAM admin access to be sure that your correct address is listed. Response to Producing Broker: Only primary brokers receive the AIR s. 30. Does the producing agent receive an notification regarding an AIR? No; only primary brokers receive notifications regarding AIRs. FAX 31. I just faxed my medical questionnaires on a quote I submitted to Underwriting (UW), how can I tell if UW has received the questionnaires? The status of your quote will tell you whether or not Underwriting has received your questionnaires. When you first submit your quote from ROAM, the status will of the quote will be Submitted to UW. Once Underwriting receives the questionnaires and starts to work on your quote, the status of the quote will change to UW Review. 32. What is the fax number I use to submit the questionnaires to UW? Is it the same that I use today when I am enrolling a customer? There are two new fax numbers that you may use to submit questionnaires. They are: and These are different numbers than the one used today to enroll a customer. 33. I realized that I forgot to include a questionnaire with my original fax. Should I wait for UW to contact me or can I fax the one(s) I did not send? Yes you can fax the additional questionnaires. Please be sure that when you fax the additional documents that, 1. You use the Tracking Cover Sheet for that quote and; 2. On the Tracking Cover Sheet you check-off the Type of Submission - Additional Information Request and; 3. You indicate, in the comment box, that you are sending additional questionnaires that were not included in the initial transmission. Note: Including all questionnaires the first time will get the fastest turnaround time from Underwriting How do I questionnaires? Create one Tracking Cover Sheet, scan the cover sheet and questionnaires and save as one PDF to attach to the . to: sgmedquest@ibx.com

6 Rates 35. How long will it take for me to get the rates back from Underwriting (UW)? If Underwriting receives all required documentation at the time of submission, the rate process should complete in three business days. Be sure that all questionnaires are complete, legible and that they are sent as soon as the request for Underwritten rates is submitted. 36. Will I be notified when UW has returned the rates for my quote? Yes, you will receive a notification when the rates are released for a quote. 37. I have been notified that UW has released the final rates for my quote, how can I access these rates? 2. When the quote list displays, select the radio button to the left of the desired quote record and then click on the Display Quote option on the left-hand menu of the screen. 4. The underwritten rates released from Underwriting display in the Underwritten Rate Summary section of the quote screen. 38. How do I view the additional products and their rates from the Underwritten Rates Screen? 2. When the quote list displays, select the radio button to the left of the desired quote record and then click on the Display Quote option on the left-hand menu of the screen. 4. Expand the Additional Products section of the quote screen to view the Medical lines of business (LOBs). 5. Expand each medical LOB to view the medical and ancillary options and rates. Customer Proposal 39. On the Final Rate screen in the Effective Date field there is a drop-down that lists a number of dates. Why? The rates received from Underwriting are valid for a specific date range (this is referred to as the Good Through Date). The dates in the drop-down are the valid coverage effective dates that fall within that range. 40. How do I generate a proposal from the Underwritten Rate Screen? 2. When the quote list displays, select the radio button to the left a quote record in Rates Released status and then click on the Display Quote option on the left-hand menu of the screen. 4. Mark the checkbox to the left of the products to be included in the proposal and then select the Create Customer Proposal PDF option from the left-hand menu of the screen. 41. How do I generate a proposal for products that are listed under the Additional Product section? 2. When the quote list displays, select the radio button to the left of the desired quote record and then click on the Display Quote option on the left-hand menu of the screen.

7 4. Expand the Additional Products section of the quote screen to view the Medical LOBs. 5. Expand each medical LOB to view the medical and ancillary options/rates and expand the Dental section to view the dental offerings/rates. 6. Mark the checkbox to the left of each desired product and then click the Add command button to the right of the medical product. 7. The products selected in the Additional Products section will then move to the Underwritten Rate Summary section and will be available for inclusion in the Customer Proposal. Quote and Enrollment Process 42. If I do not want to use the effective date I originally requested in my quote, do I have to submit a new quote? If the original quote request is still open (not in Rates Released status) the broker can reach out to their account executive. The account executive will contact Underwriting and request the effective date change. Underwriting can change the effective date if the questionnaires have been received within 90 days of the newly proposed effective date. If the quote has already been released the broker will be required to submit a new quote request. 43. I have just completed a quote. I do not see the Enroll Quote option. Why can I not enroll the quote I just completed? The quote cannot be enrolled until the quote status is Rates Released. Please refer to the status grid for the various stages of the rating and enrollment process. 44. I quoted one set of plans and am waiting for Underwriting (UW) to return my rates. The customer is interested in another plan. Do I have to submit a new quote? No, when UW completes the rating process, rates for all benefit combinations in the small group portfolio will be available for inclusion in the Customer Proposal. 45. I have just completed the initial rate and my customer is interested in pursuing coverage with IBC. Should I submit the quote to UW now or should I wait until I get the questionnaires? No, you should wait until you have received all the questionnaires before you submit to Underwriting. Sending before you have all questionnaires completed will delay the processing of your quote. 46. I have not received all the questionnaires back from the customer. Should I send what I have now or should I wait until I have them all? No, you should wait until you have received all the questionnaires before you submit to Underwriting. Sending before you have all questionnaires will delay the processing of your quote. 47. I am a producing broker. I understand that I am supposed to receive an when my primary has sent my quote to UW. I have not received an . Why? Please check with your primary broker to verify what address they have on file for you in ROAM. The will be sent to that address. 48. I received the rates back from UW, how do I enroll the quote? 2. When the quote list displays, select the radio button to the left of the desired quote record and then click on the Display Quote option on the left-hand menu of the screen.

8 4. Select the products for enrollment from the Underwritten Rates Summary section by marking the checkboxes located on the left of each desired product, and then click the Enroll Quote option on the left-hand menu of the screen. 5. Complete the Customer Enrollment Form (CEF) by making entries for all required fields (in yellow) and click the Transmit option on the left-hand menu of the screen. 6. Download the Account Installation cover tracking sheet. 7. Print the cover tracking sheet and fax it to Account Installation, along with the supporting documentation listed on the sheet. 49. Can my producing broker still enroll the quote? Yes, the enrollment process has not changed. Please keep in mind that when the producing broker enrolls the quote, the primary broker must review it first before it is transmitted to Account Installation. 50. When will I able to enroll my quote? The quote will be eligible for enrollment when the quote status is Rates Released. 51. Can I use the same tracking cover sheet to send the enrollment materials to Account Installation (AI) as I used to submit my quote? No, the processing of the medically underwritten rates for your quote and the processing of the enrollment of your customer is done by using two separate departments. Please use the tracking cover sheet to Underwriting when faxing the questionnaires, and the tracking cover sheet to Account Installation when submitting supporting paperwork for the customer's enrollment via the Account Installation process. 52. There are two tracking cover sheets. Why and what is the difference between them? The tracking cover sheet addressed to Underwriting is for submitting the medical questionnaires to Underwriting when they are processing your quote request. The tracking cover sheet addressed to Account Installation is for submitting the supporting paperwork, group enrollment, and member enrollment forms when you are enrolling the customer. 53. I am a producing broker, when will I be able to generate a tracking cover sheet for my quote? A tracking cover sheet can be generated when the quote status is Rates Released. Underwriting 54. Why do I need to have adult children and spouse signature? IBC requires the signature for privacy reasons. 55. What is the confidential envelope for? The broker sends medical questionnaires and confidential envelopes to the employer for all eligible employees applying for coverage. The questionnaires will be placed in a confidential envelope and given back to the employer. The employer will give the sealed envelopes for all employees applying for coverage to the broker. 56. When should I begin quoting October 3, 2011 for a December 1, 2011, effective date.

9 57. How long should I keep copies of the questionnaire? The Broker should keep all paper questionnaires until the case is installed, and then they can shred them. 58. Is there an audit process? Groups will be audited against the quoted census. Account Installation (AI) will match the quoted census against the applications submitted for enrollment. If there is a discrepancy, AI will reach out to the broker for additional questionnaires, if needed for a re-rate of the group. At 90 days after the effective date, there will be a look back, and any unusual enrollment activity or claims will be investigated further. 59. Does everyone need to complete Section D? If an applicant checks off any conditions in Section C, they must fill in the necessary information in Section D, or the questionnaire will be returned because it is considered incomplete. 60. One of the employees has more than five dependents. What should they do? The employee should check off the box on the bottom of the first page of questionnaire indicating they are attaching additional sheets. Then, on a blank piece of paper, write the name of the employee, signature and date, and provide all of the required information listed under Section B of the questionnaire for the additional dependents. 61. One of the employees has more than three conditions to report. What should they do? The employee should check off the box on the bottom of page three of the questionnaire indicating they are attaching additional sheets. Then, on a blank piece of paper, write the name of the employee, signature and date, and provide all of the required information listed under Section D of the questionnaire for the additional conditions. 62. What should I do if I already submitted the quote to Underwriting and now there is a change in the census? If the quote has not been released by Underwriting yet, the broker can notify the Underwriting Department by sending in the additional questionnaire and checking off Additional Information Request on the Tracking cover sheet. They must list the new hire s start date in the comments. If an employee is being removed from the census, the broker can fax in the Tracking Cover Sheet checking off Additional Information Request and noting in the comments field which employee is to be removed, and the date their employment was terminated, or reason for withdrawal. If the quote has already been released by Underwriting the broker will be required to submit a new quote request or will be notified at the time of enrollment that Underwriting is reviewing the case for a possible rerate. Questionnaires for any new hires will be required at this time. Quote and Enrollment Process 63. Why are there multiple effective dates available in the drop-down when I try to enroll the group? Underwriting will be reviewing each quote to determine if the quote is valid for future effective dates based on where the proposed effective date falls within the quarter, and if the questionnaires are still dated within 90 days. Underwriting will set the valid dates for the quote at the time the quote is released. The rates provided in the quote will be valid for any of the dates available under the effective date drop-down at the time you enroll the member.