Show:
Benefits HRP Set-Up
HC Billing
HC Eligibility
MISC
MISC
100
What is the reason why the IC should only be sending Karen the benefits set-up task when it is ready?
If the CL is not set up, Karen is unable to do the benefits set up and will need to send the task back to the IC. If the IC can ensure that the CL is set up in HRP, this would avoid having Karen to send the task back to them and then sending it back to Karen again once the CL is set up.
100
If we were billing all of September and October's premium on 9/22. Starting in October, we would be billing 1/2 of November's premium on each pay date. What is the contract start date, 1st PR, and HC start date (rollover)?
What is a client who's contract start date is 9/1, 1st payroll is 9/22(Semi-Monthly), and HC starts 9/1.
100
If the contract start date is 8/1, when is the earliest the employee’s will meet regular eligibility?
What is September 1st?
100
Fill in the blanks. When an EE reaches HC eligibility, if the EE selected box 4 on the HC-5 waiver and there is no _______ on file, benefits will need to follow up for a copy of a _________. If it is an out of state plan, benefits will need to follow up for a _____________ as well.
Insurance card / Plan Summary
100
"If there are _______ that are out of the norm, please have the IC inform Karen and I about it. Right now, we are finding it out after the fact and have to ask numerous questions"
What are exceptions?
200
When a _____ is sent to Karen, she typically gets it done that day (if she receives the ___ earlier in the day). However, it is best not to wait until the last minute as the BSCs are part of a phone queue and may have a high volume of random tasks coming in. So try to give at least 24-48 hrs until you absolutely need it done.
What is a set-up task?
200
Fill in the blank. For ______ HMSA prorates the first month of coverage, while Kaiser provides the first month of coverage free. HDS also provides the first month of coverage free. A. New clients B. Dependents over the age of 18 C. Newborns D. Spouses
What are, Newborns?
200
A Salary EE starts on September 4th for a client who’s contract start date is September 1st, what is the earliest they will be eligible?
What is October 1st?
200
Fill in the blank. Following any qualifying event, ProService must receive proper documentation within ___ days (strict deadline) to make changes to an active health care plan outside of Open Enrollment.
30 days
200
Previously, our chiro rider through HMSA and Kaiser was associated with ASH (American Specialty Health). Effective ____, The chiro benefit became embedded into the HMSA medical codes. This affected our clients as their chiropractors are now unable to process the claim under 'Chiro' with ASH with our plans, it must be processed under the 'Medical' code through HMSA. Kaiser, remains unaffected.
What was the chiro change with HMSA effective 2017?
300
Karen uses Ola’s Diamond which is a benefits tool to import the set up into HRP. If there are any changes after that is done, she manually has to make the changes. If the IC can ensure that the Benefits Questionnaire is correct, this would avoid Karen having to manually set up the benefits in HRP which can take anywhere from 30 min - 1.5 hrs depending on the complexity. What is this process?
What is the process of setting up benefits?
300
Since this CL had regular eligibility with an effective date of _____ 1st, and their 1st PR (weekly) is 8/18, we will be billing 1/2 of _____'s premiums and 1/2 of ____'s premiums on the 8/18 and 8/25 PRs.
What is September?
300
When an employee selects box 4 on an HC-5 waiver, typically PSH requires a photo of the insurance card EXCEPT for when the client is still in onboarding. If the client is still in onboarding, what do the ICs do?
The IC would verify the card and write down the information on the card on the waiver. This process is only permitted to be done by the IC and cannot be done by the client unlike the I-9 form.
300
If an EE has a child on 04/25/2017 and provides us with proper documentation within 30 days, when will the newborn's coverage begin? A. 04/01/2017 B. 04/25/2017 C. 05/01/2017
What is 04/25/2017?
300
There have been situations that an EE can have both _____ and PSH HC. However, when the EE has to check back in with ______ and _______ finds out that they are eligible for coverage through their employer, ______ may cancel their coverage due to 'ineligibility'.
What is Quest?
400
If there is a change with the set up (ex: adding a new benefit group) and the enrollment form needs to be audited, Karen needs a new _____ to be sent to her so she can set up the new group in Ola’s Diamond and manually set it up in HRP. Currently**, she only gets an enrollment form audit task and not a task to set up the new benefit group.
What is a new set-up task?
400
If we were billing September's premium across the next 3 weeks (1st PR 8/11, 2nd PR 8/18, 3rd PR 8/25) as the contract started 7/30 and October's premiums will begin billing 1/4 each week starting on the 9/1 PR. What pay schedule and HC rollover date will this CL have?
What is a client who's weekly and HC will be rolling over effective 9/1
400
If a salary employee started with the client on 9/1, but the contract start date is 9/16, what is the earliest date the employee will be eligible?
What is, November 1st?
400
When payroll or benefits notices that an employee who is on benefits has not run hours for ___ consecutive weeks, payroll will be asked to reach out to the client to see what is going on and to suggest that they remove them from health care due to reduction in hours. A. 12 weeks B. 4 weeks C. 8 weeks D. 16 weeks
What is 12 weeks? If a client pushes back and says that they would like to keep the employee on health care, benefits or payroll will provide them with our '3 Month Obligation for Health Insurance Policy' one-sheet. S Drive > Standard Operating Procedures > Benefits >
400
Fill in the blanks. When forms are sent as ________, they most likely are not 'seen' by the BSC because the assumption is that they've already been ______. When forms are sent as ______, they will be seen by the BSC when the BSC looks into the ______ new hires folder and needs to do a 'clean up'. A. Processed, Unprocessed B. Processed, Processed C. Unprocessed, Processed D. Unprocessed, Unprocessed
What is, Processed and Unprocessed?
500
For _______, we need the most current insurance bill or 4 current weeks of time sheets to verify who can be enrolled. The bill must be from a group plan and not an individual plan. For any other documentation, the IC will need to contact Karen and/or Kim to see if it is adequate.
What are HC rollovers?
500
Rule of thumb: Benefits typically won't bill to deduct more than half of an EE's paycheck. Ex 1. If the EE can't pay for it at all (example: cost is $1200 but EE only makes $1000) we would need to inform the CL to see if the CL would increase the EE pay so the EE could pay for it or the CL would end up having to pay for what the EE can't cover and it would constantly be in arrears. If that happens, we would probably advise that the EE chooses a different plan that he/she can afford. Ex 2. If the EE can afford it but it will take a huge check out of his/her check (EE makes $1200 a month and buy-up premium is $1800), then typically we would try to spread out the initial month's premiums over 2 months to the point where the EE would be able to cover the cost, even if it means that the EE will basically have a $0 check. We would also give the EE a call and let the EE know this to see if the EE would want to change to a different plan
What happens when an EE has a buy-up premium that they can’t afford?
500
For rollovers, benefits cannot be started prior to the contract start date. For example, if the contract date is 8/3/17, benefits can’t be rolled over effective 8/1/17. If there is a change in the contract start date, then the _______________________________________________.
What is, the benefits questionnaire needs to be updated with the correct contract start date?
500
Marriage/Civil Union, Newborn birth, Adoption, Involuntary Loss of Coverage, Court Order Dependent Coverage (NMSN), Move from outside of the U.S.
What are Qualifying Events?
500
Moving forward, all Active Owners needs to have __% ownership in the company. If they do not have at least this amount of ownership, they are not allowed to go on as an AO. A new form is being generated to reflect this change. Any questions about this, please speak to Elena Martinez. A. 10% B. 100% C. 50% D. 25%
What is 10%?