2015 BAW Conference
Enrollment Updates/HIPAA
Sabrina Freeman Sue Sadik Jason Simpson
October enrollment
•Enrollment options – effective January 1, 2016
•Enroll in, change or cancel health coverage (can also add or drop dependents)
•Enroll in or cancel dental/Dental Plus (can also add or drop dependents)
•Enroll in or cancel vision (can also add or drop dependents)
•Enroll in or increase Optional Life insurance by $50,000 without medical evidence (or cancel or decrease coverage)
•Enroll in Supplemental Long Term Disability (SLTD), or decrease waiting period
•Enroll or re-enroll in MoneyPlus spending accounts
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October enrollment
•Important deadlines
•Employee Benefits Services (EBS) will open for benefits administrators (BAs) on September 15
•MyBenefits will be open to subscribers on October 1 and close October 31
•All transactions on the BA console must be approved by November 16
•NOE’s and Barcode/Signature pages mailed to PEBA should be postmarked by November 16
•All supporting documentation for enrollment transactions must be received by December 1
October enrollment
•Please remember to update SLTD salary information
•EBS will open on September 15
•Complete by October 31
•PEBA will not accept late updates
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SLTD salary updates
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What’s
new in 2016?
Good news
for your employees!
•Employee premiums will not increase for the
fourth straight year!
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What’s new in 2016?
•Variable hour/full-time non-permanent
employees will be eligible to enroll in all coverages available to permanent, full-time employees
•Employee designations should be selected on
NOE or EBS
•If current variable hour/full-time non-permanent
subscriber does not make any enrollment changes their Basic Life beneficiary will default to the estate
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What’s new in 2016?
•Variable hour/full-time non-permanent
employees should be treated as new hires for Optional Life insurance purposes
•Variable hour/full-time non-permanent
employees currently being covered by Dependent Life Spouse will need to be dropped
What’s new in 2016?
•Employees are no longer required to have
completed one year of continuous state-covered service by January 1 to enroll in a medical spending account
•WageWorks will allow electronic enrollment for any
first time participants
•All participants in a medical spending account will
receive a debit/credit card, and there will be no fee
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What’s new in 2016?
•TRICARE Supplement subscribers will be eligible for
Basic Long Term Disability and Basic Life insurance
•If subscriber does not make any enrollment changes their beneficiary will default to estate
•Dependent Care Spending Account will be capped at
$1,500 for highly compensated employees.
•Internal Revenue Code defines a highly compensated employee as someone who earned $120,000 or more in calendar year 2015.
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What’s new in 2016?
•Ex-spouse coverage is not eligible for pre-tax
premiums.
•Employee covering an ex-spouse on any benefit will not be eligible for pre-tax treatment of premiums.
•Does not affect the member’s eligibility to participate in a medical spending account or dependent care spending account.
Update your
contacts via EBS
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Helpful tips
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When possible, use EBS
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When possible, use EBS
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New hires
•New hire NOE or Active Benefits Refusal form
• send for each employee in a benefits-eligible position
• send even if employee refuses coverage
• assists in Special Eligibility Situations
•Use Active Benefits Refusal forms only for:
• dependents under age 26 wishing to remain on parent’s coverage, and they will be refusing all benefits as a subscriber such as Life Insurance and Long Term Disability
• Non-Medicare eligible retirees who have returned to work
New hires
and other changes
•Send NOEs and SOEs/SOCs
•when complete and with all the required documentation
•incomplete form or missing documentation results in rejections
•Coverage is activated
•when transaction completed
•subscriber has signed within the allowed time
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New hires
and other changes
•For new hires and employees making changes during
open enrollment
•verify coverage and/or changes before making doctor appointments or getting prescriptions filled
•received card, review MyBenefits, contact vendor
•Defining “medical emergencies”
•Contact Call Center
•Paper NOE’s not accepted
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Rejections
•Clearing rejections in a timely manner is important to
assist your employees and dependents as well as ACA reporting purposes.
•Pending or rejected transactions in EBS
•delete transaction before “correcting” it by sending in a paper NOE
•include all required documentation; or
•reapprove the transaction and resend barcode with required documentation.
Rejections and suspense
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Suspense
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Rejections
Rejections
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Documentation
•It is helpful for you to put an asterisk or star by the
effective date or other pertinent information on documentation.
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Requests for review
•A Request for Review may be submitted either by
subscriber request or due to a clerical error/delay.
•explain what the situation is and any contributing factors that caused the delay or error
•include NOE with the requested change
•include all necessary paperwork and documentation
•dependent documentation
•loss/gain of coverage letters
•maximum one year retro
•retro premiums will apply for retro coverage
•it is helpful to indicate if the subscriber has been paying premiums or at least they are aware they will be due
Requests for review –
eligibility appeals
•If request for review is denied:
•only subscriber may appeal within 90 days
•request for review has 90 day language with address
•appeals are legal process and takes time to complete
•If appeal is denied
•subscriber may seek judicial review by filing a case at the Administrative Law Court
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Assisting retirees
•Terminate new retiree’s active coverage as soon as
paperwork is complete
•Remember, it is easier to terminate coverage through
EBS
•Quickly terminating your retiring employees’ active
coverage will help your former coworkers avoid inconveniences
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Questions
Security
•EBS no longer automatically refreshes.
•The BIN replaces SSN on Summary of Enrollments and
Summary of Changes (SOE and SOC).
•Dependents and beneficiaries SSN have the first 5
digits as “X” and appear as XXX-XX-1234.
•PEBA redacts any Social Security numbers before
sending paperwork or correspondence.
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Security and
privacy reminders
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•Name
•Five digit ZIP codes
•Dates related to an
individual:
•DOB
•admit
•discharge
•DOD
•all ages over 89
•Telephone numbers
•Fax numbers
•Electronic mail
addresses
•Social Security numbers
•Medical record
numbers
•Health plan beneficiary
numbers
•Account numbers
Protected
•Certificate/license numbers
•Vehicle identifiers and
serial numbers, including license plate numbers
•Device identifiers and
serial numbers
•Web Universal
Resource Locators (URLs)
•Internet Protocol
address numbers (IPs)
•Biometric identifiers,
including finger and voice prints
•Full face photographic
images and comparable images
•Any other unique
identifying number, characteristic or code
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Protected
health information (PHI)
Workstation
use and security
• Access of PHI without subscriber authorization must
be limited to purposes permitted
• Staff shall not load unauthorized software, programs
or files onto their workstations
• Staff shall not copy records onto personal devices
• Monitors should be positioned such that
unauthorized persons cannot view information
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Workstation
use and security
• Do not share your password with anyone. This
includes IT and your supervisor. Additionally, do not write your password on sticky notes or other paper and leave it around or near your computer.
• Do not use someone else’s account or spoof or send
emails that appear to have originated from one source when actually they were sent by another source.
• Staff must lock their workstations when leaving work
area for extended periods.
and malicious software
• Do not open emails unless you know the sender. If
you receive email from an unknown sender, contact IT.
• Please inspect email addresses carefully to ensure
they are from a legitimate source.
• Do not open links in emails without confirming with
the sender the validity of the links.
• Do not give your work email address for any personal
emails.
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and malicious software
• Never download files from the Internet.
• Never install any personal software on your
computer.
• Do not make illegal copies of any software.
• Notify your supervisor if you suspect your password
has been compromised.
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Logins
•Immediately report any of the following to your
supervisor:
• If someone is using another’s password
• If someone is asking for your password
• If your screen suddenly looks different
• If there is any other unusual or out-of-the ordinary situation
Transmissions
• Every effort will be made to avoid or limit the
transmission of PHI via electronic means (e.g. faxing or emailing); and then, only with the proper protocols and disclaimers in place.
• Any documents to be sent via fax should be sent via
electronic fax, if possible. If not possible, the sender must remain at the machine until the transmission is complete to remove material from the machine.
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Transmissions
• Fax machines and copiers should also be regularly
checked for, and cleared of, material containing PHI.
• Emails containing PHI should be sent using the
encrypted secure email function. Avoid full SSN whenever possible especially if you don’t have encrypted email.
• Documents containing PHI must be placed in the
locked shred bins.
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Transmissions
•No materials containing PHI may be left on
photocopiers, fax machines or exposed on any work area.
•Telephones, voicemail and answering machines are
not secure. Don’t discuss PHI over speakerphone and do not leave messages containing PHI on an answering machine.
•Be certain that you are talking to the subscriber or
their authorized representative when giving subscriber information over the phone, just as if you were providing the information in person.
Physical
security safeguards
•Employees must clear desks and workspaces of
any sensitive documents or PHI at the end of each workday and place these documents in a secure location to prevent inadvertent disclosure.
•All unsecured areas (desks, work areas, faxes,
copiers, etc.) should be cleared of all documents containing PHI when not in use.
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Questions
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Disclaimer
This presentation does not constitute a comprehensive or binding representation regarding the employee benefits offered by the South Carolina Public Employee Benefit Authority (PEBA). The terms and conditions of the retirement and insurance benefit plans offered by PEBA are set out in the applicable statutes and plan documents and are subject to change. Please contact PEBA for the most current information. The language used in this presentation does not create any contractual rights or entitlements for any person.
