The "H.I." Life
This metal tier is typically the least expensive in terms of monthly premium, but likely carries a high deductible.
What is "bronze"?
The ____ team is responsible for locating group approvals and auditing the carrier records for accuracy against Hippo.
What is "Confirmation"?
You are responsible for paying your insurance premiums each month directly to the carrier, but Gusto will help you to set up automatic payments when possible.
After Gusto submits an application for health insurance on behalf of a group, the insurance carrier responds with follow up question and a request for additional documents. This is commonly referred to as a _____.
What is "pending item"?
The meaning of "DIFOT".
What is "Delivered in Full on Time"?
This type of plan has a large network of providers that employees can see without a referral. It also provides coverage for out-of-state employees.
What is "PPO"?
When Qualification completes their review and fills out the TTIA note, the benefit order status switches to ____.
What is "Ready for OE Prep"?
"Do all of my employees really have to log-in for Open Enrollment if they don't want to sign up for insurance?"
Yes, all eligible employees will need to log in to confirm whether or not they would like to participate in the insurance plans. Insurance carriers will need to see proof that all full-time employees were given the option to enroll. And, if they elect to waive coverage, the reason why they are not participating.
The team that an OA tickets when a group asks to review additional plan options.
Who is "New Plan Sales/Advising"?
The number of paychecks in a year that an employee will receive if they are paid "bi-weekly".
What is "26"?
Gusto acts as the ___ between an employer and an insurance company. This means that we advise on plans, assist with account set up and management, and receive commission payments.
What is "broker"?
The name of the note that OAs must fill out before the order status will change to "Ready for Submission Prep".
What is the "TTS"?
"What happens if one of my enrolled employees gets fired or leaves the company?"
If a member of your team leaves during the year, a request to terminate their coverage will automatically be filed to our Member Processing team once you process their employment termination in Gusto. They will then be sent information on how to enroll through COBRA/State Continuation. This will all happen automatically and will not require any additional action from you.
The team that receives the ticket if there were errors made on the Group application.
Who is "Submission"?
Flowers-by-Jen Inc. has 12 FT eligible employees. At their most recent Open Enrollment, 4 EEs enrolled, 6 waived with a valid waiver reason, and 2 waived because coverage was too expensive. The group's participation % is ____.
What is "67%"? (Or 66.6666667%)
Per the ACA, this is the maximum waiting period that employers can impose on new hires before their benefits are active.
What is "90 days".
The OA can move the group to fulfilled once all Carrier Orders have the status of ____
What is "Approved"?
"Can an employee change their benefit selections at any time during the year?"
An employee may only change their election during the year if they experience a Qualifying Life Event. These are events such as marriage, divorce, birth of a child, etc. This process can be initiated by the employee through their Gusto account at any time. Once complete, our Member Processing team will make sure this gets updated with the insurance carrier.
The ticket reason used by the OA when the group has stopped responding and has failed to provide the necessary documents to complete the insurance application.
What is "Unresponsive ER"?
This entity type has owners known as "2% shareholders", and the IRS recommends that the company pay for 100% of their insurance premiums.
What are "S-Corps"?
With the exception of CA, NY, VT, and CO, employers with less than __ number of employees qualify for the small group market.
What is "50"?
The Benefit Order status when all employees have completed Open Enrollment OR the final OE Window extension date has passed.
What is "OE Verification/Checking Participation"?
"What happens if my plans are not approved before the 1st"?
If that were to happen, approval would have still have a retroactive start date of [EFFECTIVE DATE], which means your employees can submit manual claims for covered services between the start date and the final processing date to be reimbursed.
To submit claims, your team should request receipts of payment from their doctors, which they'll submit to the carrier for reimbursement. If the care they received is covered by their plan, the carrier will reimburse them after they've processed and approved your company's benefits.
The status of a Benefit Order when Confirmation or Submission locates a request from the insurance company which will require a conversation with the group Admin.
"What is ER Outreach Required"?
The day you can expect that a Q3 Quarterly Wage Report (QWR) would be available in Panda for a group that has been using Gusto for payroll.
What is "October 15th"?