2012 Individual Open Enrollment FAQ's
How do I log in to the website?
What is being sent to the client?
Where do Brokers find renewal information?
What do I have to do if I’m not changing anything about my coverage?
Why are the rates so high?
When can I change my plan?
What can I do to get my costs down?
Why shouldn’t I go to the Connector since they are saying that their rates are going to be lower?
How has National Health Care Reform changed things?
What are the different out-of-pocket expenses?
What is the Out-of-pocket maximum?
When do I complete a new enrollment kit?
How long before we receive our ID cards?
What is a qualifying event?
Can I be reinstated if I terminate?
Who do we contact if we have questions about a claim?
What do I receive for my membership with HSA?
How will we be billed?
How do I pay my bill?
Who do we contact if there is a question about our plan benefits or billing?
Which carriers allow for Domestic Partner Coverage?
For purposes of my State tax return, how will I prove that I am insured?
Can I enroll in a Dental Plan?
How do I log in to the website?
If you are a Broker: Broker website instructions
If you are a Client: Client “Quick Guide” including website instructions
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What is being sent to the client?
Clients will receive:
All other other plan specific material can be found on the website in the “Products” section under “bulletins” for each carrier.
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Where do Brokers find renewal information?
Brokers can access their renewal information by logging in to the broker portal at: www.hsainsurance.com
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What do I have to do if I’m not changing anything about my coverage?
You don’t have to do anything if you are staying on the same plan. Your current plan will renew with the new rates.
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Why are the rates so high?
First we need to review how rates are derived;
- It starts with something called the “base rate,” which is a dollar amount that the health insurer needs to charge for an “average” customer. These base rates are given to the Massachusetts Division of Insurance for review and if they are not disapproved they are officially “placed on file” which means they are made available to the marketplace. Once the base rate has been established Massachusetts law allows certain rating factors to be applied.
Rating factors applied;
- Age: The age of the individual enrolled.
- Geographic location: The home address is considered since certain areas of the state have hospitals, physicians and other providers that are much more or less costly than other areas.
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When can I change my plan?
- You may only make changes to your current plan or change carriers within the Open Enrollment period, which is July 1st through August 15th for Individuals. Your renewal materials will include this information.
â–ºPlan downgrade or upgrade during Open Enrollment: Changing plans within the same carrier:
- Online:You can view your options by logging in and following the “self service menu” options. A list of all options within the carrier will be listed; choose the plan that most suits your needs and click “submit”. Your plan change requests will be forwarded immediately to our Enrollment Department where it will be processed.
- Paper: you may select your plan change option from the list of options sent by mail with your renewal. Select the plan, sign and return to our enrollment department by:
- Brokers can submit online and paper (broker must sign) same carrier plan changes on behalf of their clients.
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What can I do to get my costs down?
Look at options with the same carrier.
- Review your renewal via Intranet
- Discuss a downgrade and the impact of more out of pocket costs and higher co-pays/deductibles
Look at options with another carrier.
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Why shouldn’t I go to the Connector since they are saying that their rates are going to be lower?
· At HSA, we have more creative ways to save you money; more products, more Tier structures, (2T and
3T) which allow you to save money. The Connector has less choice, less service and only 4T rating.
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How has National Health Care Reform changed things?
The following are two of the significant changes taking place as a result of the Patient Protection and Affordable Care Act (PPACA) also known as Federal health care reform:
- Young-adult dependents may stay on a family policy until their 26th birthday regardless of marital or student status. Dependents not active on a family plan, but are younger than age 26, may be added back to the plan when the group renews on April 1, 2011.
- Preventive Services: Cost sharing (copay, deductible or coinsurance) will be removed on specified preventive care services effective April 1, 2011.
- Why is this so significant?
- With no cost sharing for preventive services, you will no longer have out of pocket costs for services that would normally have gone to the deductible. You may now consider deductible plans with the knowledge that you will not being paying out of pocket for most preventive services. For the most part, only non-preventive services will be subject to the deductible. Here is a list of preventive services now covered with no cost sharing.
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What are the different out-of-pocket expenses?
Copayment: A fixed amount that you pay each time you receive a covered service,
such as a doctor’s office visit or a covered prescription.
Deductible: A set amount of money that you may be responsible for each year for certain kinds of medical services. Once you have paid the yearly deductible in full, you are covered for those services for the rest of the year. However, you may need to pay copayments or coinsurance for certain services.
Coinsurance: A fixed percentage of covered medical charges that you may be responsible for paying. The coinsurance amount will be specified in your Schedule of Benefits or Summary of Benefits. An example of coinsurance could be that your health plan covers 80% of covered medical charges and you are responsible for the remaining 20%.
For Tufts’ presentation on how deductibles and co-pays work, click here.
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What is the Out-of-pocket maximum?
A dollar amount determined by the carrier that places a limit on the amount of expenses you pay for specific services during a particular time period, typically a year. This may only apply to certain services, you should check your particular plan’s benefit summary for details.
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When do I complete a new enrollment kit?
Changing Carriers: client must complete a full enrollment kit
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How long before we receive our ID cards?
This differs with each carrier. The usual time is 2-3 weeks from the time we receive and process the applications at MBA. Cards are generated by the Health Carrier. During Open Enrollment, there may be additional delays to this process due to volume; for this reason, we recommend you submit forms as soon as possible.
- Please note; regardless of whether you have received your ID card, your coverage is active on the first of the month of the requested effective date, provided all materials, documents and payment have been received in due time and have passed Underwriting approval.
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What is a qualifying event?
Birth; Adoption; Legal guardianship of a child, Marriage; Divorce/Annulment; Legal Separation; Dependent gains other coverage; Employee/Dependent loses other coverage; Dependent becomes eligible; Dependent no longer eligible; Death of dependent; Domestic partner dissolution; Court ordered dependent; Dependent moves into Service Area.
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Can I be reinstated if I terminate?
Some carriers will allow a reinstatement, some will not. Please contact our customer service dept. If you are reinstated, there is a $50 reinstatement fee.
email: customerservice@hsainsurance.com or call (781) 228-2222 FAX (781) 848-7020
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Who do we contact if we have questions about a claim?
Please contact the Carrier’s member services department. We cannot speak with a client about claims. It is prohibited by the HIPAA law (Health Insurance Portability and Accountability Act of 1996).
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What do I receive for my membership with HSA?
You can view a list of our membership benefits on the website. https://www.hsainsurance.com/About-Us.aspx
In addition to membership discounts on various products, MBA is on the forefront of advocacy on behalf of clients and brokers. Our mission is always to represent the best interests of small business on behalf of our members.
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How will we be billed?
Bills are sent 35 days in advance of the coverage month. Payment is due by the first of the coverage month. A $25 late fee assessment is sent out on the 10th of the coverage month to any member who has not paid. Coverage will be terminated on the first day of the coverage month for payment not received by the 20th of the covered month.
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How do I pay my bill?
There are three ways to pay your bill:
- Online Bill Pay: Click on “Click Here to Pay Your Bill Online” on our homepage. This will lead you to our banking partner, Unibank, where you can pay your bill in just seconds. Please be careful to enter the correct bank account information as any errors will result in a bank charge of $20.
- Pay by check: mail to our office, MBA, 135 Wood Rd, Braintree, MA, 02184
- Pay by Wire Transfer: please contact our Customer Service department for instructions; (781)228-2222.
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Who do we contact if there is a question about our plan benefits or billing?
You may contact our Customer Service Department
email: customerservice@hsainsurance.com or call (781) 228-2222 FAX (781) 848-7020
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Which carriers allow for Domestic Partner Coverage?
The following is a list of the carriers allowing domestic partner coverage. Affidavits are required for most and are available on our website.**.
- HPHC (Affidavit Required)
- HNE (Affidavit Required)
- Fallon (Affidavit Required)
- NHP (NO Affidavit required, must be indicated on enrollment form)
- BCBSRI
- TUFTS (Affidavit Required; Tufts requires employers to choose this option only at OE)
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For purposes of my State tax return, how will I prove that I am insured?
Subscribers will receive a “1099-HC” form in the mail. Use this form when completing your state taxes. If you do not receive a “1099-HC” form, contact your carrier’s member services department at the number listed on your ID card.
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Can I enroll in a Dental Plan?
Yes, several Delta Dental options are available to individuals. Click here for information on those plans.
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