Enrollment Updates/HIPAA

Transcription

1 2015 BAW Conference Enrollment Updates/HIPAA Sabrina Freeman Sue Sadik Jason Simpson October enrollment Enrollment options effective January 1, 2016 Enroll in, change or cancel health coverage (can also add or drop dependents) Enroll in or cancel dental/dental Plus (can also add or drop dependents) Enroll in or cancel vision (can also add or drop dependents) Enroll in or increase Optional Life insurance by $50,000 without medical evidence (or cancel or decrease coverage) Enroll in Supplemental Long Term Disability (SLTD), or decrease waiting period Enroll or re-enroll in MoneyPlus spending accounts 2 October enrollment Important deadlines Employee Benefits Services (EBS) will open for benefits administrators (BAs) on September 15 MyBenefits will be open to subscribers on October 1 and close October 31 All transactions on the BA console must be approved by November 16 NOE s and Barcode/Signature pages mailed to PEBA should be postmarked by November 16 All supporting documentation for enrollment transactions must be received by December 1 3 1

2 October enrollment Please remember to update SLTD salary information EBS will open on September 15 Complete by October 31 PEBA will not accept late updates 4 SLTD salary updates 5 What s new in 2016? 6 2

3 Good news for your employees! Employee premiums will not increase for the fourth straight year! 7 What s new in 2016? Variable hour/full-time non-permanent employees will be eligible to enroll in all coverages available to permanent, full-time employees Employee designations should be selected on NOE or EBS If current variable hour/full-time non-permanent subscriber does not make any enrollment changes their Basic Life beneficiary will default to the estate 8 What s new in 2016? Variable hour/full-time non-permanent employees should be treated as new hires for Optional Life insurance purposes Variable hour/full-time non-permanent employees currently being covered by Dependent Life Spouse will need to be dropped 9 3

4 What s new in 2016? Employees are no longer required to have completed one year of continuous state-covered service by January 1 to enroll in a medical spending account WageWorks will allow electronic enrollment for any first time participants All participants in a medical spending account will receive a debit/credit card, and there will be no fee 10 What s new in 2016? TRICARE Supplement subscribers will be eligible for Basic Long Term Disability and Basic Life insurance If subscriber does not make any enrollment changes their beneficiary will default to estate Dependent Care Spending Account will be capped at $1,500 for highly compensated employees. Internal Revenue Code defines a highly compensated employee as someone who earned $120,000 or more in calendar year What s new in 2016? Ex-spouse coverage is not eligible for pre-tax premiums. Employee covering an ex-spouse on any benefit will not be eligible for pre-tax treatment of premiums. Does not affect the member s eligibility to participate in a medical spending account or dependent care spending account. 12 4

5 Update your contacts via EBS 13 Helpful tips 14 When possible, use EBS 15 5

6 When possible, use EBS 16 When possible, use EBS 17 New hires New hire NOE or Active Benefits Refusal form send for each employee in a benefits-eligible position send even if employee refuses coverage assists in Special Eligibility Situations Use Active Benefits Refusal forms only for: dependents under age 26 wishing to remain on parent s coverage, and they will be refusing all benefits as a subscriber such as Life Insurance and Long Term Disability Non-Medicare eligible retirees who have returned to work 18 6

7 New hires and other changes Send NOEs and SOEs/SOCs when complete and with all the required documentation incomplete form or missing documentation results in rejections Coverage is activated when transaction completed subscriber has signed within the allowed time 19 New hires and other changes For new hires and employees making changes during open enrollment verify coverage and/or changes before making doctor appointments or getting prescriptions filled received card, review MyBenefits, contact vendor Defining medical emergencies Contact Call Center Paper NOE s not accepted 20 Rejections Clearing rejections in a timely manner is important to assist your employees and dependents as well as ACA reporting purposes. Pending or rejected transactions in EBS delete transaction before correcting it by sending in a paper NOE include all required documentation; or reapprove the transaction and resend barcode with required documentation. 21 7

8 Rejections and suspense 22 Suspense 23 Rejections 24 8

9 Rejections 25 Documentation It is helpful for you to put an asterisk or star by the effective date or other pertinent information on documentation. 26 Requests for review A Request for Review may be submitted either by subscriber request or due to a clerical error/delay. explain what the situation is and any contributing factors that caused the delay or error include NOE with the requested change include all necessary paperwork and documentation dependent documentation loss/gain of coverage letters maximum one year retro retro premiums will apply for retro coverage it is helpful to indicate if the subscriber has been paying premiums or at least they are aware they will be due 27 9

10 Requests for review eligibility appeals If request for review is denied: only subscriber may appeal within 90 days request for review has 90 day language with address appeals are legal process and takes time to complete If appeal is denied subscriber may seek judicial review by filing a case at the Administrative Law Court 28 Assisting retirees Terminate new retiree s active coverage as soon as paperwork is complete Remember, it is easier to terminate coverage through EBS Quickly terminating your retiring employees active coverage will help your former coworkers avoid inconveniences 29 Questions 30 10

11 Security EBS no longer automatically refreshes. The BIN replaces SSN on Summary of Enrollments and Summary of Changes (SOE and SOC). Dependents and beneficiaries SSN have the first 5 digits as X and appear as XXX-XX PEBA redacts any Social Security numbers before sending paperwork or correspondence. 31 Security and privacy reminders 32 Protected health information (PHI) Name Five digit ZIP codes Dates related to an individual: DOB admit discharge DOD all ages over 89 Telephone numbers Fax numbers Electronic mail addresses Social Security numbers Medical record numbers Health plan beneficiary numbers Account numbers 33 11

12 Protected health information (PHI) Certificate/license numbers Vehicle identifiers and serial numbers, including license plate numbers Device identifiers and serial numbers Web Universal Resource Locators (URLs) Internet Protocol address numbers (IPs) Biometric identifiers, including finger and voice prints Full face photographic images and comparable images Any other unique identifying number, characteristic or code 34 Workstation use and security Access of PHI without subscriber authorization must be limited to purposes permitted Staff shall not load unauthorized software, programs or files onto their workstations Staff shall not copy records onto personal devices Monitors should be positioned such that unauthorized persons cannot view information 35 Workstation use and security Do not share your password with anyone. This includes IT and your supervisor. Additionally, do not write your password on sticky notes or other paper and leave it around or near your computer. Do not use someone else s account or spoof or send s that appear to have originated from one source when actually they were sent by another source. Staff must lock their workstations when leaving work area for extended periods

13 and malicious software Do not open s unless you know the sender. If you receive from an unknown sender, contact IT. Please inspect addresses carefully to ensure they are from a legitimate source. Do not open links in s without confirming with the sender the validity of the links. Do not give your work address for any personal s. 37 and malicious software Never download files from the Internet. Never install any personal software on your computer. Do not make illegal copies of any software. Notify your supervisor if you suspect your password has been compromised. 38 Logins Immediately report any of the following to your supervisor: If someone is using another s password If someone is asking for your password If your screen suddenly looks different If there is any other unusual or out-of-the ordinary situation Don t login from a free Wi-Fi connection 39 13

14 Transmissions Every effort will be made to avoid or limit the transmission of PHI via electronic means (e.g. faxing or ing); and then, only with the proper protocols and disclaimers in place. Any documents to be sent via fax should be sent via electronic fax, if possible. If not possible, the sender must remain at the machine until the transmission is complete to remove material from the machine. 40 Transmissions Fax machines and copiers should also be regularly checked for, and cleared of, material containing PHI. s containing PHI should be sent using the encrypted secure function. Avoid full SSN whenever possible especially if you don t have encrypted . Documents containing PHI must be placed in the locked shred bins. 41 Transmissions No materials containing PHI may be left on photocopiers, fax machines or exposed on any work area. Telephones, voic and answering machines are not secure. Don t discuss PHI over speakerphone and do not leave messages containing PHI on an answering machine. Be certain that you are talking to the subscriber or their authorized representative when giving subscriber information over the phone, just as if you were providing the information in person

15 Physical security safeguards Employees must clear desks and workspaces of any sensitive documents or PHI at the end of each workday and place these documents in a secure location to prevent inadvertent disclosure. All unsecured areas (desks, work areas, faxes, copiers, etc.) should be cleared of all documents containing PHI when not in use. 43 Questions 44 Disclaimer This presentation does not constitute a comprehensive or binding representation regarding the employee benefits offered by the South Carolina Public Employee Benefit Authority (PEBA). The terms and conditions of the retirement and insurance benefit plans offered by PEBA are set out in the applicable statutes and plan documents and are subject to change. Please contact PEBA for the most current information. The language used in this presentation does not create any contractual rights or entitlements for any person