Individual Special Enrollment Period Verification

June 27, 2017

Starting July 1, 2017, enrollment in an individual plan outside of the Open Enrollment Period will require documentation to verify the qualifying event.

The requirement applies to all individual members (except those on short-term plans). We will verify Special Enrollment Periods (SEPs) for members on direct and transitional plans. The Marketplace will handle verification for members on Marketplace plans. The Marketplace is taking a phased approach in verifying SEPs, but we are not. We will require verification for all qualifying events starting July 1.

Documentation should be included with the enrollment application. If no documentation is included, we will send a letter asking for the required info by mail, email, or fax within a specified time frame. If we don’t receive documentation within that time frame, the application will be denied.

The due date for required documentation will be either 30 days from the notice of the missing documentation or the end of the SEP, whichever is later.

For example, for people applying due to loss of other coverage:

  • If they apply on the first day of their 60-day SEP period, they have 60 days to return documentation.
  • If they apply on the 30th day of their 60-day SEP period, they have 30 days to return documentation.
  • If they apply on the 45th day of their 60-day period, they have 30 days to return documentation.

The effective date of coverage is always based on the qualifying event, not the date they return their documentation.

For more information, review our SEP documentation guide on Your Health Alliance for brokers. The guide includes required documentation for each qualifying event.

New Small Group Private Exchange

We’re excited to announce we now have an online quoting and enrollment tool for new fully insured small group sales. This new user-friendly platform will better serve you and those shopping for our plans.

You can quote small group prospects up to 90 days before the effective date, so you can currently quote July 1, August 1, and September 1 effective dates. You can enroll groups up to 5 days after the effective date. For example, you have until July 5 to enroll a group with an effective date of July 1.

You can enroll a group using a spreadsheet, or employees can complete their applications online. We will continue to accept small group requests for proposal (RFPs) through email. Submit the request to Quotes@healthalliance.org, and we’ll send the quote to you as we do today.

To access the new exchange, visit HealthAlliance.org/Groups, choose the Small Group Plans page, and use the “New to Health Alliance? Get a Quote & Enroll Online” button at the top of the page. You can also access the exchange through Your Health Alliance for brokers.

Please plan to call in to one of our Q&A sessions about the new exchange. Before the session, check out the training video and training guide in the Forms & Resources section of Your Health Alliance for brokers.

  • June 28, 4 p.m. CT
  • June 29, 10 a.m. CT

Q&A call-in info: 1-800-747-5150, access code 7225952

Contact your client consultant with any questions.

July 31 Reporting Deadline for PCORI Fees

Check out this helpful reminder from Benefit Planning Consultants (BPC):

Reminder: The July 31 reporting deadline for PCORI fees is quickly approaching for many. Do you need to file?

As we enter into the summer months, BPC would like to remind you of the July 31 reporting deadline for PCORI fees. Plan sponsors of self-funded health plans, including Health Reimbursement Arrangements (HRAs), must file IRS Form 720 by July 31 and pay a fee of a little more than $2 per participant. Health FSA and HSA programs are exempt. Determining whether you need to file for your plan to remain compliant is relatively simple, and BPC can help.

The Patient-Centered Outcomes Research Institute (PCORI) was created by the Affordable Care Act (ACA) to support clinical effectiveness research and is funded partially by fees paid by health insurance carriers and health plan sponsors.

BPC wants to give you the tools to be sure that your clients have paid the PCORI fees for their plans. The BPC website offers you a self-service guide to help answer any PCORI questions you may have, as well as PCORI fee reporting services.

New: Out-of-Area Coverage for College Students

June 20, 2017

We now have a solution for college students who attend school outside of our service area.

Through our new College Extended Network Program, dependent children who leave our service area for 90 consecutive days or more to attend a college, university, technical school, or vocational school can get access to the national PHCS Healthy Directions and Multiplan networks while at school for no additional cost.

The dependent college student will receive a special ID card and can search the PHCS/MultiPlan networks through Your Health Alliance. All other family members on the plan will keep their current ID cards and will use the standard provider network.

Who Can Participate

  • College students only (not dependent children living outside service area for other reasons)
    New and existing fully insured large and small groups
  • HMO, POS, and PPO groups
  • Self-funded groups can choose to offer the benefit
  • Not available to members on individual plans

Other Details

  • We will begin accepting student certification forms on July 1, 2017. This form is available in the Forms & Resources section of Your Health Alliance for brokers.
  • Extended coverage for eligible dependents begins August 1 for 12 months and must be renewed with a new form each year.
  • The program is automatically included for fully insured small and large groups for no additional fee.
  • Self-funded groups can add the benefit for no administrative fee. An additional cost for the use of the MultiPlan network will apply.
  • There is no cost to the member to participate.
  • Students attending schools within our Illinois/Iowa seamless network aren’t eligible for the program.
  • Retrospective participation in the program is not allowed. Participation will start August 1 for those who submit forms before the academic school year begins. Otherwise, participation will be effective the first day of the following month after we receive the completed form.
  • When getting care from PHCS/MultiPlan providers, members are responsible for making sure preauthorization is requested for services that require it. They can call customer service to check if a service requires preauthorization.
  • We will remind members to submit new forms each year before their dependent’s extended coverage expires.

For questions, employees should call the customer service number on the back of their ID cards, and employers should contact their client consultants.

Tell Us Other Languages You Speak

May 16, 2017

Because of an increase in requests for Spanish-speaking brokers, we are asking you to email HABrokerContracting@healthalliance.org with any other languages you speak. We would prefer to only receive this if you are fluent or comfortable presenting product information in that language.

We’ll keep these languages on file for when someone requests information or an appointment with a broker who speaks a language other than English.

Fully Insured Small and Large Group June Renewals

May 9, 2017

Small and large fully insured groups with a June 1, 2017 renewal date will be auto-renewed on May 15. Groups can make plan changes through June 30.

Even though the groups will be auto-renewed, please email your client consultant the signed Exhibit B and Exhibit C. We’ll send the group enrollment agreements (GEAs) to employers through DocuSign. Please ask your clients to sign and send the documents back to us as soon as possible.