Embed Size (px)
Citation preview
GaBreeze WebinarJob Aids Overview
WINTER 2012
February 2010 2APRIL 2010
Session Purpose
Topics to Discuss
Key Business Processes– COBRA
– Employee Eligibility
– Evidence of Insurability
– LOA Summary Matrix
– Qualified Status Change
– Retirement
General Job Aids– Agency Audits
– File Sharing
February 2010 3APRIL 2010
KEY BUSINESS PROCESSES
February 2010 4APRIL 2010
Location of Key Business Processes
http://www.spa.ga.gov/employees/flexible_benefits.asp
February 2010 5APRIL 2010
COBRA
February 2010 6APRIL 2010
COBRA Job Aid (1)
What Is COBRA ?
COBRA is the continuation rights available to employees and their qualified beneficiaries pursuant to the Consolidated Omnibus Budget Reconciliation Act. This act permits former employee and their qualified beneficiaries continue coverage up to 18 months
Which Options can be covered by COBRA
Dental
Vision
Health Care Spending Account
February 2010 7APRIL 2010
COBRA Job Aid (2)
Billing Process:
GaBreeze processes COBRA enrollment and sends a monthly invoice directly to participant(s).
February 2010 8APRIL 2010
ELIGIBILITY PROCESS
February 2010 9APRIL 2010
Employee Eligibility
A full-time regular employee who works at least thirty hours a week and is expected to work for at least nine months
Public School Professionally Certified Employees working at least 17.5 per week
Public School Non-Certified Employee working at least 20 hours per week & eligible to participate in TRS or its local equivalent.
Public School Non-Certified Employee working at least 15 hours per week & eligible to participate in PSERS or its local equivalent.
County or Regional Library Employees working at least 17.5 per week
In an organization deemed eligible by Federal or Georgia Law.
Eligibility Job Aid (1)
February 2010 10APRIL 2010
Dependent Eligibility:
Legal Spouse
Natural Child, stepchild, adopted child until age 26
Guardianship of child until age 26
Total Disable child age 26 or older if disable child is enrolled before age 26
Dependent Verification:•SPA accepts verification done through State Health•SPA reserves the right to request dependent documentation
Eligibility Job Aid (2)
February 2010 11APRIL 2010
Coverage Eligibility
Coverage begins the first of the month following a full calendar month worked.
Payroll deductions begin first of the month following newly eligible status effective date
Example: Hired March 8th; coverage effective date May 1st
Coverage Termination
Employee terminates before the 16th of the month Coverage ends last day of the month
Example: Termed June 12th Coverage ends June 30th
Employee terminates on or after the 16th of the month Coverage ends last day of the following month
Example: Termed June 19th Coverage ends July 31st
STD & LTD coverage ends on the date of termination
Eligibility Job Aid (3)
February 2010 12APRIL 2010
EVIDENCE OF INSURABILITY PROCESS
February 2010 13APRIL 2010
Evidence of Insurability (EOI):
Series of medical questions: employees may be requested to have a medical exam
Employee continues coverage at the guaranteed issued amount until EOI is approved
EOI is approved with 60 days. Increase becomes effective the 1st of the month following approval
Employee will receive a prompt to complete the EOI online or if enrolling through Call Center form is mailed
Evidence of Insurability Job Aid (1)
Plans Requiring EOI:
Employee Life, Spouse Life, Specified Illness, Spouse Specified Illness, LTD & LTC
Triggers:
Newly eligible employee enrolling in coverage that exceeds the guaranteed issued amount
Current employee enrolling in coverage for the first time during Annual Enrollment or QSC
February 2010 14APRIL 2010
Evidence of Insurability Job Aid (2)
EOI process is a paper process for LTC & Specified Illness
February 2010 15APRIL 2010
LEAVE OF ABSENCE (LOA) PROCESS
February 2010 16
LOA Availability Matrix
Leave of Absence Job Aid (1)
February 2010 17
What Employees can do when:
Leave of Absence Job Aid (2)
February 2010 18APRIL 2010
QUALIFIED STATUS CHANGE
February 2010 19APRIL 2010
Qualified Status Change Job Aid (1)
What is a Qualifying Status Change?
A personal change, life event change, in status which may allow you to change your benefit elections
Marriage or divorce
Birth or adoption of a child
Death of a spouse or child
Loss of coverage
QSC become effective on the first of the month following the DATE the change is reported regardless of the actual QSC date. Birth/adoption effective on the date of the event.
Example: Employee marry on Feb 7th , reports status to GaBreeze on Feb. 23rd changes effective March 1st (require recoup of the difference in premiums)
Example: Employee marry on Feb 7th , reports status to GaBreeze on March 5th changes effective April 1st (will not recoup of the difference in premiums)
February 2010 20APRIL 2010
RETIREMENT PROCESS
February 2010 21APRIL 2010
Retirement Job Aid (1)
Coverage Continuation:
Retiree Dental - coverage continues automatically if currently enrolled (no form to complete; Confirmation Kit )
Pension Deduction
Direct Billed
Changes can be made during the annual enrollment period
Vision & *Health Care Spending - continue through COBRA for 18 months
Life, Specified Illness, LTC,*Legal - coverage continuation through Conversion or Portability
*Notes benefit options that can only be kept for the duration of the Plan Year in which they end active employment.
February 2010 22APRIL 2010
Retirement Job Aid (2)
Benefits
Retiree Coverage Available Through
Retirement Plan Benefits Deductions
Coverage Can Be Direct Billed By Carrier or
Converted to An Individual Policy
You Must Decide And complete forms Within
Dental Coverage
Regular & PPO Yes No
DHMO Option Yes Yes 30 days
Vision Coverage No No COBRA -60 days
Health Care Spending Accounts No No COBRA - 60 days
Dependent Care Spending Account No No
Employee/Spouse/Child Life Insurance & AD&D No Yes 30 days
Specified Illness No Yes 30 days
Disability / Coverage
Short-Term No
Long-Term No Yes 30 days
Legal Insurance No Yes (Through end of the plan year) 30 days
Long-Term Care No Yes 30 days
February 2010 23APRIL 2010
GENERAL JOB AIDS
February 2010 24APRIL 2010
Agency Audit & File Share Job Aid
Agency Audit:
Allows users to see the reports processed by each Agency user
Smart Forms
Reporting
Files
Agency Information
File Share:
Allows file sharing of reports between SPA, GaBreeze and your agency
February 2010 25APRIL 2010
Final Questions and Follow-ups
