SiMON FRASER UNIVERSITY
16 pages
English
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SiMON FRASER UNIVERSITY

Le téléchargement nécessite un accès à la bibliothèque YouScribe
Tout savoir sur nos offres
16 pages
English

Description

  • cours - matière potentielle : proposals
  • cours - matière potentielle : forthe
  • cours - matière potentielle : number
  • cours magistral
  • exposé - matière potentielle : courses on a trial basis
  • cours - matière potentielle : prerequisites
  • cours - matière potentielle : outline
  • cours - matière potentielle : proposals for bisc
  • cours - matière potentielle : proposal form
SiMON FRASER UNIVERSITY MEMORANDUM To ............... .SENATE ............................................................. . From ....... SENATE...CO4ITTEE ... ON ... UNDERGRADUATE ............ STUDIES Subject ..... NEWQURSEPRQPOS4kS ... -BIQCIENCES. ............ Date ....... SEPTEMBER ... 10,....1975 ......................................... ............... MOTION: That Senate approve, and recommend approval to the Board of Governors, the new course proposals for BISC 403-3 - Microbial Ecology BISC 471-3 - Special Topics in Biology BISC 472-3 - Special Topics in Biology BISC 473-3 - Special Topics in Biology, as set forth in S.75-I1.
  • presentation of courses on a trial basis
  • microbial ecology
  • techniques for the assessment of microbial production
  • study of microbial ecology
  • microbes
  • ecology
  • courses
  • course

Sujets

Informations

Publié par
Nombre de lectures 18
Langue English

Exrait

Agent Guide
for Small Employer GroupsAssurant Health offers group health insurance plans designed to meet
the varied needs of small employers. Assurant Health’s extensive portfolio,
along with its commitment to efficient and responsive service, can make
your job easier.
Assurant Health is the brand name for products underwritten and issued by
John Alden Life Insurance Company and Time Insurance Company and is the
name used in this guide when referring to either insurance company.
Agent Guide and Supplements
The Agent Guide is a handy reference tool that gives you the information
you need to write and retain business with Assurant Health. The electronic
format of the guide provides you with access to the most up-to-date
information. If you have questions about this information or any other
part of doing business with Assurant Health, please contact your sales
representative.
There are state-specific supplements to this Agent Guide that cover
variations to the general guidelines. The information in the state
supplements override the guidelines in the Agent Guide. The Agent Guide
and the state supplements are for agent use only and are not intended for
distribution to the general public.

IMPORTANT NOTeS:
Please make sure your client doesn’t cancel existing coverage until you have
received written approval of the new plan from Assurant Health.
If there is a conflict between the information contained in this guide or any
state supplement and the contract/certificate, or any state and/or federal law
or regulation, the contract/certificate or state/federal law or regulation will
take precedence.
Manage Your Business with MyBook
MyBook provides you with online access to your client information for
these lines of Assurant Health business — Individual, Group and Short
Term. Plus, MyBook keeps you up-to-date on the status of your business
through alert notices. To receive e-mail alerts make sure your e-mail
address is always updated at the Assurant Health Sales site. You can easily
search for a particular client or sort and view business according to your
management needs. To learn more about MyBook, see the information
on page 12 and view the brief training module in the Agent Library at
assuranthealthsales.com.Coverage changes (page 10) What’s New?
Plan design changes can be made on the group’s renewal
11/2011 edition date or one other time during the year.
Network changes are allowed on renewal date or 6 months Requests to Withdraw Group Coverage (page 2)
post renewal. We allow a 10-day window from the date of activation
Changes on a group level can be made to dental plan designs, for a group to withdraw their request for coverage. If a
including the addition of orthodontia coverage (provided request is not received within this time period, group
the group meets the qualifications for such coverage), on the coverage can only be terminated as of the end of the
group’s renewal date or one other time during any calendar billing month.
year. Changes on an employee level can be made on the
Health History Underwriting (page 3) group’s renewal date or January 1 or 15 (date is dependent on
Gathering Requirements
the group’s billing cycle). Requests to drop dental coverage
To assist you and your client when additional information
may be limited to the group’s renewal date or January 1 or 15
is required during the enrollment process, a member of the (date is dependent on the group’s billing cycle).
Assurant Requirement Team (ART) will contact the group A group may add Employee Choice (see Plan Options
or employees to obtain the necessary information. This is
on page 6) to their plan on the group’s renewal date or
a highly qualified and customer focused staff. ART will
one other time during any calendar year. An employee
work directly with the group contact and employees to may only switch between medical plans on the group’s
obtain the requirements needed to finalize your case. In renewal date or January 1 or 15 (date is dependent on the
order to ensure compliance with privacy laws, all medical
group’s billing cycle), unless the switch is due to a physical
requirements must be gathered directly from the employee.
relocation of an employee. Changes can be made by
Utilizing ART not only provides you with more time, it completing Section B of the Employee Enrollment Form.
helps to protect you against privacy situations and insures
Life/AD&D (page 11)
compliance with privacy laws.
To add or increase benefits, a fully completed, signed and
HIPAA Privacy dated Employee Enrollment Form must be submitted to
As a business associate of Assurant Health and as a Assurant Health. Requests to add or remove Life/AD&D
representative working on behalf of each applicant, it is coverage on a group level can be made at any time.
your responsibility to protect the confidential information Requests to increase/decrease Life/AD&D coverage can be
you collect. HIPAA privacy and security regulations made on the group’s renewal date or January 1 or 15 (date
require that you, as a business associate, have the physical, is dependent on the group’s billing cycle).
administrative, and technical safeguards in place to protect All requests are subject to underwriting review.
this information. Please refer to the Assurant Health Short Term Disability (page 11)
privacy policy at www.assuranthealth.com to understand To add or increase benefits, a fully completed, signed and
how protected health information is handled at Assurant
dated Employee Enrollment Form must be submitted to
Health and information on how insureds can exercise their Assurant Health. Payroll records are required to verify
individual rights under HIPAA. Please contact Assurant employee salaries (minimum of 90 days). Requests to add
Health Privacy Office immediately if you are aware of any or remove STD coverage on a group level can be made at
breach of protected health information.
any time.
Premium Only Plan (POP) (page 7) Requests to increase/decrease STD coverage can be made
on the group’s renewal date of January 1 or 15 (date is While the option of a Premium Only Plan arrangement is
dependent on the group’s billing cycle). available to groups of all sizes, Assurant no longer offers a
comprehensive Premium Only Plan through our vendor. It All requests are subject to underwriting review and
is the employer’s responsibility to administer the POP. approval and may be declined.
Termination of Coverage (page 11) Maternity Coverage (page 7 & 10)
The health care reform law has put new restrictions on Maternity benefits are optional. Maternity coverage can be
terminations, particularly with respect to employers and added at any time. If maternity coverage was elected after
insureds. the group was initially issued, maternity coverage must
Before submitting a request for a retroactive termination, remain on the group plan for a minimum of 24 months.
employers must ensure that premium has not been received Changes or requests to drop maternity can be made on the
from the employee beyond the requested termination date. group’s renewal date of January 1 or 15 (date is dependent on
When processing a termination, Assurant Health relies on the group’s billing cycle). If maternity coverage is dropped, it
the information employers provide, such as the last date cannot be re-added at a later date.
of employment of eligibility for coverage, the termination
Rate Guarantee (page 8)
date being requested, the paid-to-date of the group and if
The total monthly premium can change on a group if the
the employee has paid for coverage. Complete and accurate
number of employees insured changes by the greater of 10%
information must be provided.
or two employees.























































Table of Contents
Pre-Screen Process 2 Coverage Options 7
Maternity Coverage 7Effective Dates — New Groups 2
Life Insurance and AD&D Coverage 7
How to Submit a Case 2
Short Term Disability (STD) Coverage 7
Requests to Withdraw Group Coverage 2
Ineligible STD groups 7
Health History Underwriting 3
Workers’ Compensation Coverage 8
Gathering Requirements 3 Rates 8
HIPAA Privacy 3 Adding Employees and/or Dependents 9
Nondiscrimination Requirements
Adding Newborn or Adopted Dependents 9
under Federal Law 3
Enrollment Periods 9
Eligibility Requirements 4
Timely Enrollment 9
Group Eligibility 4
Special Enrollment 9
Employee Eligibility 4
Late Enrollment 10
Husband and Wife Employment 4
Effective Dates — Additions to
Dependent Eligibility 4
Existing Groups 10
Adopted Dependents 4
Timely Employee and Dependent(s) 10
Participation Requirements 5 For Groups with a Zero-Day Employment
Medical 5 Waiting/Affliation Period 10
Valid Waivers 5 Special Enrollment Employee
and/or Dependent(s) 10 Dental 5
Late Employee and/or Dependent(s) 10 Participation and Eligibility Review Process 5
Coverage Changes 10Contribution Requirements 5
Medical 10Employment Waiting/Affliation Periods 5
Maternity 10
Pre-Existing Conditions and
Dental 10 Continuity of Coverage 5
Employee Choice 11 Pre-Existing Conditions Limitation 5
Life/AD&D 11 Continuity of Coverage 6
Short Term Disability (STD) 11 Continuity of Coverage — Dental 6
Termination of Coverage 11Plan Options 6
Employer Kit 12 Employee Choice 6
Health Savings Account (HSA) 6 Premium Payment and Billing 12
Health Reimbursement Arrangement (HRA) 7 Grace Periods 12
Premium Only Plan (POP – Section 125) 7 Claim Submission and Service 12
Myaccount for Online Convenience 12
MyBook for Managing Your Business 12







6. Completed New Business TEFRA survey for Submitting Business
groups of 20 or fewer total employees where there
is an employee or spouse age 64 or older. Assurant Health’s group insurance plans are fee-for-
service products offering numerous plan design choices 7. S tate Unemployment Wage and Tax statement.
and options. You can design a wide range of coverage, Groups without Unemployment Wage and Tax
from the very richest protection to basic, catastrophic contribution reports will be required to submit
coverage, depending on the needs of your client. other business tax documentation and/or employee
compensation reports.Assurant Health offers the following group insurance
coverage: Medical, Dental, Life and Short Term Disability. 8. Employer Contribution and Group Size Form.
Please make sure your client understands that Assurant
Pre-Screen Process
Health will review the case before making any
The pre-screen process allows you to provide your final determinations including approving coverage,
customers with an estimated cost of obtaining medical determining the final premium amount, assigning an
coverage prior to actual enrollment. Assurant Health effective date or changing any terms of coverage.
makes every effort to provide you with an accurate
The Underwriting Department must receive complete
rating, however, medical ratings may change based on
documentation before this review can be completed.
complete information and full medical underwriting at
They will work with you and your client to obtain
the time of enrollment.
complete information.
If information needed to finalize a case is not received Effective Dates — New Groups
by Underwriting after appropriate follow ups have been
A group may request a specific effective date that is
performed, the case will be closed.
within the 60-day period after the date enrollment
If it is later discovered that relevant facts about a group, materials are signed. Available effective dates are the
employee or dependent have been omitted or misstated, 1st and 15th of the month on or after the date we receive
the following actions may occur once complete and complete enrollment materials.
correct information is submitted:
1. Assurant Health will review and determine How to Submit a Case
whether to change any terms of coverage.
Please submit the following documentation:
2. If Assurant Health would not have issued coverage
1. A fully completed Employer Participation if the correct facts were known, coverage may
Agreement/Application, signed and dated by be terminated.
the employer and agent(s). Certain states require
3. If the relevant facts affect the amount of premium,
the use of a state-specific Employer Participation
an adjustment of premium back to the effective
Agreement/Application.
date may be made on the employer’s bill.
2. A fully completed, signed and dated Employee
Enrollment Form or Waiver of Coverage form
Requests to Withdraw Group Coverage
for each eligible employee (including owners,
partners, corporate officers) and dependents, We allow a 10-day window from the date of activation for a
including those in the employment waiting/ group to withdraw their request for coverage. If a request
affiliation period or those eligible for state is not received within this time period, group coverage can
continuation or COBRA. Certain states require the only be terminated as of the end of the billing month.
use of a state-specific Employee Enrollment form.
3. A signed proposal/quote (must include all pages
of the proposal/quote).
4. The most current prior billing statement if the
group is replacing a previous employer plan.
5. A check from the firm (agent/agency checks are
not accepted) for the amount of the first month’s
quoted premium made payable to Assurant Health.

Agent Guide for Small Employer Groups 2Gathering RequirementsUNDeRWRITING PROCeSS
To assist you and your client when additional
Health History Underwriting information is required during the enrollment process, a
Assurant Health has the right to investigate medical member of the Assurant Requirement Team (ART) will
conditions including, but not limited to, requiring a contact the group or employees to obtain the necessary
blood or urine profile and/or an attending physician’s information. This is a highly qualified and customer
statement. focused staff. ART will work directly with the group
contact and employees to obtain the requirements needed The underwriter may call the employer and/or
to finalize your case. In order to ensure compliance employees. These calls entail a short interview with
with privacy laws, all medical requirements must be the employer or employee with the focus of clarifying
gathered directly from the employee. Utilizing ART not information reported on the Employer or Employee
only provides you with more time, it helps to protect you Enrollment Forms or to obtain missing information.
against privacy situations and insures compliance with See Gathering Requirements for more details.
privacy laws.
Assurant Health does not use or collect genetic
information for any underwriting purpose. Genetic
HIPAA Privacy
information includes information related to genetic tests,
As a business associate of Assurant Health and as a genetic counseling, or any family history of a disease or
representative working on behalf of each applicant, disorder. Any such information should not be included
on an application or communicated to Assurant Health in it is your responsibility to protect the confidential
any manner. information you collect. HIPAA privacy and security
regulations require that you, as a business associate, have Applicants are required to disclose information
the physical, administrative, and technical safeguards regarding any disease or condition for which they or any
in place to protect this information. Please refer to the person applying for coverage has:
Assurant Health privacy policy at www.assuranthealth.
• B een d ia g n osed o r t re a ted b y a n y he a l t h ca re com to understand how protected health information
provider is handled at Assurant Health and information on how
• Been co n f i n ed i n a h osp i ta l , res i d en t ia l t re a t m en t insureds can exercise their individual rights under
center, mental health, or medical facility HIPAA. Please contact Assurant Health Privacy Office
immediately if you are aware of any breach of protected • Been seen b y a n y he a l t h ca re p ro v i d e r f o r
health information.emergency services, routine follow-up or ongoing
medical care
Underwriting Guidelines • R ecei v ed co n su l ta t i o n, t re a t m en t , t he r a p y , a d v i ce
or undergone any testing Nondiscrimination Requirements
under Federal Law • Been a d v ised o f t he n ecess i t y o r poss ib i l i t y o f a n y
The nondiscrimination rules under the Tax Code future diagnostic testing, consultation, treatment,
apply to employers purchasing group coverage after follow-up, or surgery
September 23, 2010, or whose coverage becomes If the whole group cannot be issued as applied for, you
“un-grandfathered.” These are a series of rules for
will be contacted before any coverage is issued. The offer
employers that concern availability of benefits and
of coverage, including a final premium amount, will be
required contribution limits to members. made after underwriting is complete.
Because the laws surrounding testing for compliance
are complicated and fact-specific, an employer should
consult a tax advisor when making decisions regarding
plan eligibility and contribution levels to determine
compliance with these laws.
Agent Guide for Small Employer Groups 3employees who work only part of the calendar year on Eligibility Requirements
the basis of natural or suitable times or circumstances.
Group eligibility
Several states allow independent contractors to
Assurant Health is committed to ensuring fair and enroll if they meet the requirements outlined above.
equitable practices and procedures to assist you and your The independent contractor must work exclusively
employer applicants through the process of applying for for the employer insured through Assurant Health.
coverage. All small employers, regardless of health status,
Husband and Wife employmentclaims experience, industry, occupation or geographic
location*, have equal access to health insurance coverage. Husbands and wives working for the same employer
It is an unfair trade practice for either an insurer or an on a full-time basis may elect to enroll EITHER as two
employees or as an employee and dependent spouse. agent to do any of the following:
If the husband and wife are the only eligible employees 1. Encourage or direct small employers to refrain
and they enroll under one medical certificate, they from filing an application for coverage because
meet the requirements for consideration as a small of health status, claims experience, industry,
employer group.occupation or geographic location* of the small
employer; or When an individual enrolls as a dependent spouse,
only the dependent ancillary products are available 2. Encourage or direct small employers to seek
to that person.coverage from another carrier because of health
status, claims experience, industry, occupation or Dependent eligibility
geographic location* of the small employer; or
Eligible dependents include the insured employee’s
3. Induce or otherwise encourage a small employer
lawful spouse and their naturally born children,
to separate or otherwise exclude an employee from
adopted children or children placed for adoption with
health coverage or benefits in connection with the the insured employee, stepchildren, or children
employee’s employment.
for which the insured employee is the legal guardian.
*You can consider geographic area for the purposes of a restricted
Eligible dependent children must be age 25 or younger.
service area or restricted network.
An unmarried dependent, age 26 or older, may continue
Assurant Health’s group eligibility criteria include:
until the dependent is no longer a full-time student in an
1. The business must be actively providing a product accredited institution of postsecondary education.
or service to the public on a regular, full-time
An unmarried dependent, age 26 or older, on a medically
basis while operating under a legal status as a
certified leave of absence from a postsecondary
proprietorship, partnership or corporation.
institution may continue coverage until the date that is
2. The business cannot continue to offer other similar one year following the first date of the medical leave, or
group insurance (HMO or indemnity) once they the date coverage would otherwise terminate under the
are covered under an Assurant Health plan. terms of the plan.
Regardless of age, a child incapable of self-sustaining employee eligibility
employment or engaging in the normal and customary An eligible employee is any person who performs
activities of a person of like age because of mental services on a full-time basis (defined as at least 30
incapacity or physical handicap is eligible if chiefly hours per week) at any of the employer’s business
dependent on the insured employee for financial support establishments and is considered an employee for
and claimed as an exemption on the insured employee’s federal employment tax purposes.
most recent federal income tax return. Proof of
A partner, proprietor or corporate officer of the
eligibility must be provided.
employer is eligible if he/she performs services for
the employer on a full-time basis (defined as at least Adopted Dependents
30 hours per week), at any of the employer’s
An adopted child is eligible as a dependent when the
business establishments.
certificate holder has agreed to assume total or partial
The term “Employee” does not include: a) retirees or responsibility of support for a child in anticipation of
persons who are not expected to perform any duties, adoption or legal physical placement of the child in the
responsibilities or services for the employer; b) “part- home. Appropriate documentation must be provided.
time” employees; or c) any “seasonal” or “temporary”
Agent Guide for Small Employer Groups 4Participation and eligibility Review ProcessParticipation Requirements
The group must maintain participation requirements
Medical
throughout the life of the contract. Assurant Health
Two sets of participation requirements must be met for a
may send renewal questionnaires, call groups or
group to be eligible for coverage.
request payroll records to verify participation and
1. 50% of all full-time, eligible employees must enroll, eligibility information at any time. Groups that do not
regardless of waivers; and maintain participation requirements or supply the
requested information to verify continued compliance 2. In groups of three or fewer eligible employees, all
with eligibility and participation requirements may full-time, eligible employees without valid waivers
be terminated.must enroll. In groups of four or more eligible
employees, 75% (100% if the employer pays 100%
of the employee’s premium) of all full-time, eligible Contribution Requirements
employees without valid waivers must enroll.
The employer must pay at least 50% of the employee’s
premium. The employer determines whether Valid Waivers
employees are responsible for paying all or part
When medical coverage is waived because an
of their dependents’ premiums.
employee has existing comprehensive major
medical coverage, the waiver is considered to
Employment Waiting/Affiliation
be a valid waiver. Valid waivers are:
Periods
• C o v e r a g e u n d e r a spo use’ s em p l o y e r g ro u p
major medical plan Employment waiting/affiliation periods of 0, 30, 60, 90
• C o v er a ge u n d er a n i n di v i d ua l ma jo r m edi ca l p la n and 180 days for future employees are available in most
• M edi ca re states. One employment waiting/affiliation period must
• Medicai d be selected for all classes of employees. If a group does not
• TR I CARE select an employment waiting/affiliation period at time of
• C o v er a ge u n d er a n In dia n H ea l t h Ser v i ces Prog r a m application, a default period of 30 days is assigned.
• S ta te hea l t h benefi ts r is k poo l
• C O B R A co v er a ge Pre-Existing Conditions and
Dental Continuity of Coverage
Dental plans are available to all size groups enrolling Pre-existing Conditions Limitation
for major medical coverage. The dental plan may also be
Pre-existing conditions are those for which medical
written as a standalone product with a minimum of
advice, diagnosis, care or treatment was recommended
three covered employees. Optional orthodontia is
or received within six months prior to the effective date
available for groups with at least 10 covered employees.
for new group members and late enrollees, or the date
When dental coverage is purchased with medical, the
of hire for timely enrollees. Pre-existing conditions are
dental participation requirement is the same as for not covered for 12 months. Late enrollees are subject
the medical coverage. to an 18-month pre-existing conditions limitation. This
Participation requirements for the standalone dental provision applies to medical and prescription drug
product are: coverage only.
Groups of four or less — 100% of all full-time, eligible This limitation does not apply to enrollees age 18
employees must enroll — no waivers are allowed. or younger and maternity. Newborn and adopted
children are not subject to the Pre-Existing Conditions Groups of five or more — 75% (100% if the employer pays
Limitation when an enrollment request is received 100% of the employee’s premium) of all full-time, eligible
within 31 days of birth, adoption or placement.employees without valid waivers must enroll.
The only valid waiver for dental coverage is under a
spouse’s comprehensive employer dental plan.
Dental offices and dental labs are ineligible for
dental coverage.
Agent Guide for Small Employer Groups 5Continuity of Coverage Plan Choice is available to groups with the following
number of enrolling employees:The Pre-Existing Conditions Limitation is reduced by
the amount of time a person was covered under prior • 3 – 2 4 en ro l l i n g em p l o y ees qua l i f y f o r 2 p la n s
creditable coverage, provided there was no more than • 25 o r m o re en ro l l i n g em p l o y ees qua l i f y f o r
a 63-day gap between coverages. For timely enrollees up to 3 plans
and dependents enrolling with them, the group’s
Employers can offer multiple plan options so that
employment waiting/affiliation period is not counted
employees can select the one that best suits their needs.
as part of the gap.
The Main Business location is always where the
Creditable Coverage includes the following: “headquarters” is located unless there is a majority
of eligible employees working elsewhere at another • A g rou p ma jo r m edi ca l p la n
location. In that case, the employer is allowed to choose
• A n i n di v i d ua l ma jo r m edi ca l p la n
the “main location” (between the headquarters location
• Medicare or the majority of eligible employees location).
• Medicai d Branch locations are business locations with a different
• TR I CARE o r o t he r g o v e r n m en ta l p la n address than the main business location. A branch
location with more than five enrolling employees may • In dia n H ea l t h Ser v i ce o r t r ib a l o rga n i za t i on
select a different plan than the main location. medical care program
• S ta te r is k poo l Health Savings Account (HSA)
• F ed er a l Em p l o y ee H ea l t h Benefi t Prog r a m An HSA is a federally authorized tax-free savings
• Pub l i c hea l t h p la n account that can be used to pay current and future
qualified medical expenses. Either the employer, • P ea ce C o r p hea l t h p la n
employee, or both may fund an HSA. Participants must
• S h o r t T er m o r Li m i ted d u r a t i on hea l t h p la n
enroll in a qualified high deductible health insurance
• S ta te Chi l dren ’ s H ea l t h In su r a n ce Prog r a m
plan and then set up an HSA. Assurant Health offers a
• T AA qua l i fied i n di v i d ua ls variety of specially designed plans that can be coupled
with a Health Savings Account. Cancer-only, hospital-only and other non-major medical
limited benefit plans are not creditable coverage. Assurant Health offers a comprehensive account
administration program called HSA Tools. This program Continuity of Coverage — Dental
provides the convenience of an integrated approach to
The waiting period for timely applicants for certain
service both the health insurance plan and the Health
dental services is waived when the applicant is replacing
S a v i n gs A cco u n t – a l l a t n o a d d ed cos t . Y o u r cl i en t has
prior major dental coverage, provided there was no more
the option of choosing his/her own HSA administrator.
than a 31 day gap between coverages, exclusive of any
Every year the Department of Labor reviews the
employment waiting/affiliation period.
qualified HSA deductibles and out-of-pocket maximums
based on the Consumer Price Index (CPI) and may make Plan Options
cost of living adjustments (COLA) to them. As a result,
employee Choice all insurance companies selling HSAs are required to
re-evaluate their HSA deductibles and out-of-pocket This feature allows small employers the flexibility to
maximums to make sure they are within the new range. offer multiple plan designs and networks. Assurant Health
If an adjustment is required, all groups with the HSA offers Network Choice, Plan Choice and options for
deductible and out-of-pocket maximums that are no branch locations.
longer qualified will be automatically changed to ones Network Choice is available to groups with two or more
that are within the new range. The change will be made covered employees. Wherever possible, Assurant Health
effective January 1st and the group will be notified once offers a choice of provider networks, which enables most
the change has been made.
covered employees to select a network that includes their
For more information, please refer to the Real Choices current providers.
HSA and HRA brochure, Form 51686 and HSA Tools
brochure, Form 50501.
Agent Guide for Small Employer Groups 6Health Reimbursement Arrangement (HRA) Life Insurance and AD&D Coverage
A Health Reimbursement Arrangement is a tax-favored Life and Accidental Death & Dismemberment (AD&D)
program set up and paid for by the employer. Under coverage is optional. However, when elected by the
the HRA, the employer reimburses a portion of each employer, all enrolling employees must elect
employee’s qualified medical expenses. Life/AD&D coverage.
The advantages of an HRA include a reduction in the Assurant Health offers dependent life insurance
premiums when the HRA is coupled with a high coverage. When elected, this coverage is included
deductible health insurance plan. Premium savings for all enrolling dependents.
are often enough to cover any medical expense Life insurance coverage is medically underwritten
reimbursements. HRA reimbursements are also 100% and may be declined or offered at an adjusted
tax deductible. amount or premium.
Assurant Health offers specially designed plans, with
Short Term Disability (STD) Coveragea wide range of options, to meet the varied needs of
STD coverage is designed to provide employees with small employers.
weekly income if a disability caused by injury or illness
For your clients’ convenience, Assurant Health
occurs while covered by an Assurant Health major
recommends Employee Benefits Corporation (EBC) for
medical plan.
HRA administration. When EBC is selected, your clients
STD coverage is available to eligible groups enrolling have the convenience of electronic claims submission
three or more employees for major medical coverage. from Assurant Health directly to EBC. Your client may
If elected, STD coverage is included when an employee choose his/her own HRA Administrator.
enrolls for major medical coverage. Assurant Health’s
For additional information, refer to the Real Choices
Underwriting Department may require additional
HSA and HRA brochure, Form 51686.
health history in the form of questionnaires, inspection
reports or medical reports in order to issue STD coverage.
Premium Only Plan Assurant Health reserves the right to decline or offer
(POP – Section 125) different coverage to any employee.
A POP enables employees to pay their portion of group Ineligible STD groups
insurance premiums on a pre-tax basis. It also reduces
The following are not eligible for STD coverage:
the payroll taxes paid by the employer.
• Ai r po r ts , f l y i n g fi el ds , a n d ser v i ces
POPs are available to groups of all sizes. It is the
• Am usem en t en ter p r ises , en ter ta i ners , employer’s responsibility to administer the POP.
professional sports
For more information, please refer to POP flyer,
• A n i ma l a n d v eter i na r y ser v i cesForm 50514.
• A u to m ot i v e rep a i r , ser v i ce , o r p a r k i n g
• B a rber a n d bea u t y sh o psCoverage Options
• B a rs , cl ubs a n d sa l oon s
Maternity Coverage
• Bo w l i n g cen ters
Maternity benefits are optional. Maternity coverage can be
• Chem i ca l a n d asbestos ha n dl i n gadded at any time. If maternity coverage was elected after
• Chem i ca l d epen d en c y cou n sel o rsthe group was initially issued, maternity coverage must
remain on the group plan for a minimum of 24 months. • Chi l d da y ca re ser v i ces
Under the Federal Pregnancy Discrimination Act, • Cl ea n i n g a n d ma i d ser v i ces
employers with 15 or more employees must cover
• C on st ru c t i on – bu i l di n gs , roa ds , roo fi n g
expenses for routine maternity costs (including for
• D a n ce st u di os , sc h oo ls a n d ha l ls
spouses of male employees) on the same basis as
• Di rec t h o m e sa l es o r a n y busi ness o per a t i ng costs for other medical conditions.
strictly out of the home
If maternity coverage is dropped, it cannot be re-added at
• Em p l o y m en t a n d person nel ser v i cesa later date.
• Exp l osi v es o r fi re w o r k ma n u f a c t u rers a n d ha n dl ers
Agent Guide for Small Employer Groups 7

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