Q. Why should I self-fund my group's health
plan?
Q. Can I choose an HSA under the self-funded
small group plan?
Q. What are my options if the health of my group
deteriorates?
Q. Who would be my first point of contact for
service resolution?
Q. When I add employees, do I receive a new
quote for their monthly contribution or use the composite rate?
Q. After the policy has been issued, do new
employees go through medical underwriting before they are eligible for
enrollment?
Q. If at the end of the year I am due a refund
from my claim fund account, when could I expect the check?
Q. Why is it necessary to have a 6-month claims
run-out?
Q. If an employee is eligible for coverage on the
22nd of the month, can his/her enrollment start on the 22nd of that month?
Q. Do employees' deductibles and copays go
towards the Aggregate and Specific Deductibles?
Answers
Q. Why should I self-fund my group's health plan?
A. Self-funding can be financially advantageous if your small
business claims experience is at or below the norm among groups who purchase
conventional insurance (fully-insured). Assurant Health combines the service
and protection you and your employees need for comfort, convenience and
financial security.
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Q. Can I choose an HSA under the
self-funded small group plan?
A. We offer HSAs with five qualified high deductible health plans. We offer a $2,500 individual deductible in the 100/50, 90/70, 80/60, 70/50 and 50/50 plans (network/out-of-network).
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Q. What are my options if the health of my group deteriorates?
A. Assurant Health carefully selects small businesses for stop loss coverage that we believe are likely to benefit from a self-funded plan. However, due to emerging health conditions, unexpected costs may make self-funded plans less advantageous for some employers. Those employers may gain better results by obtaining fully insured coverage. In Colorado, when an employer leaves a self-funded plan to purchase a fully insured plan, some carriers may charge an additional premium in the first year of up to 35%, based on health conditions.
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Q. Who would be my first point of contact for service resolution?
A. For assistance with stop loss premium questions, customer service and claims inquiries, please contact us at 1-866-387-0489. For medical authorization questions, please call 1-866-387-3407.
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Q. When I add employees, do I receive a new quote for their monthly contribution or use the composite rate?
A. Once you have signed your proposal, the established rate will be used as the monthly rate for any new employees within that policy year. However, if your census changes by more than 20% within a given year, it may result in a change in rates.
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Q. After the policy has been issued, do new employees go through medical underwriting before they are eligible for enrollment?
A. Eligible employees only go through underwriting at the beginning of each policy year. If a new employee starts in the middle of a policy year, he/she will be considered with the entire group at renewal time.
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Q. If at the end of the year I am due a refund from my claim fund account, when could I expect the check?
A. After the policy year is over, Assurant Health allows six months for all claims incurred in the prior policy year to be processed. If money is remaining in your claim fund account at the end of the six months, it can be refunded to you within the following month.
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Q. Why is it necessary to have a six-month claims run-out?
A. The six-month run out period ensures that outstanding claims that were incurred prior to end of the policy are processed.
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Q. If an employee is eligible for coverage on the 22nd of the month, can his/her enrollment start on the 22nd of that month?
A. Coverage for new employees (excluding newborns and adopted children) will become effective on the first day of the group's effective date following the date of eligibility. For example, if the group's effective date is the 15th of the month, new employee coverage will begin on the 15th of each month.
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Q. Do employees' deductibles and copays go towards the Aggregate and Specific Deductibles?
A. Deductibles, coinsurance and copays do not apply toward the Aggregate and Specific deductibles.
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