Administrating Your Benefit Plan


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The most important part of your group plan is being informed of your benefits and the details of your coverage. The only way an employee can know exact details is to read their certificate booklet. Covered employees can register with the carrier online and produce a certificate book, make changes such as addresses, view claims, look up providers, request an id card and other functions. Carriers now have wellness programs online, as well as other programs such as smoking cessation. An alternative to reading through a certificate booklet is to read a benefits summary description. Upon request we will furnish those for you. It is our practice to provide them to our clients at renewal time or plan change. They are 8 to 10 pages and are very inclusive of most questions anyone would ask.


Your company has established a waiting period for new employees. Beginning in 2014 upon renewal it cannot be longer than 90 days. The coverage for a new employee will go in effect on the date you have established. Our office must receive the enrollment form within 30 days of the date the coverage will be effective. Should we not receive the enrollment within that time frame the next available time for that employee to enroll will be open enrollment, which is your renewal date. All enrollments can be faxed to our office at 678-999-4985. You can also e-mail them. Anytime that you send us an enrollment you will receive a confirmation. Should you not receive a confirmation that would mean your transmission did not reach us and you should contact our office to resend it to us. We will provide you upon request plan summaries with enrollment forms.


A qualifying event is when you have an employee or their dependent that has not enrolled in your plan because they have other coverage. When they have a loss of coverage due to a loss of employment or loss of eligibility they may come on your plan at that time. We must receive their application or change form in our office within 30 days from the time they loose their coverage or have a qualifying event. The requirements for adding an employee or their dependents are a HIPAA letter, which is a letter from their previous insurance carrier which they are required to provide them with. If the letter is not available at the time you complete the enrollment or change form it can follow when it is received. The coverage will be keyed in for them but not activated until the letter is received by the carrier your firm is covered through. This letter will state the date their coverage went into effect and the date it was terminated. We will also need a change form if an employee is adding a spouse or children or an enrollment for the employee if the employee was covered under the spouses plan as a dependent.


Newborn children are covered from date of birth but we will need a change form completed and signed within 30 days of their birth listing their name, d.o.b. New spouses and stepchildren are covered from the date of marriage. We will need a change form within 30 days of marriage along with a copy of the marriage license. Should we not receive these forms within the required period of time they will not be able to cover those dependents until open enrollment. (Your renewal) The administrator of a group plan can also make these changes online with the carrier by signing up online. When choosing that option no forms are needed.


Please use a cancellation form to terminate employees or dependents. If you don’t have a change form please contact our office. Complete and fax to our office for processing. You may also complete these transactions online with the carrier.


Many clients are not aware of the fact that nearly all insurance carriers for any type of group product have an actively at work clause. What this means is that should you have an employee or person on your plan they must be a full time time employee on your payroll and actively at work. Inactive employees cannot be enrolled in a group plan. Employers should communicate to employees the length of time they can remain covered while out on a medical leave. Should this ever be the case please call us so we can communicate with the carrier to provide guidance. Some carrier’s will allow 1099 employees and some will not. Even those who do allow 1099’s have stipulations such as they cannot receive a 1099 from anyone but you, some carriers will limit the % of those on your plan who are 1099’s. The most common occurrence for employers is when someone goes out on an indefinite medical leave of absence. Should it be for more than a week or so the employee who goes out on leave should either be placed on C.O.B.R.A. or the state of Georgia continuation. When they return to work they can be taken off of continuation and be listed as a regular employee. There is a different set of rules for a business that has more than 50 employees under the family medical leave act.


When you have an employee who waives coverage you should have them sign a waiver and keep a copy of it in your files. Please send our office a copy of all declination’s and waivers as it will be helpful when assisting you. It would be a good idea for your HR or administrator to keep a set of all of the forms mentioned above in employee’s files.


It is very important every month to review your statement to make sure that terminated employees have been taken off of your billing statement and new employees are added. Premiums are due on either the 1st or the 15th (most are on the 1st) your plan has a 30 day grace period and there is a danger in going past the 30 days. Example an employee is hospitalized and the hospital attempts to verify coverage and the carrier can say they have been terminated due to non-payment you are at the carriers mercy as to whether they want to pay or deny the claim. It would be prudent to make sure payments are posted by the 30th of the month, nearly all carriers let you pay online so it is convenient. A carrier most of the time will terminate your coverage if your premium is not posted by the 30th and will require an approval to reinstate.

Agency directory
B. Wayne Gladden LUTCF 770-932-5927 extension 201
Jeanette Donaldson c.s.r. 770-932-5927 extension 202
Lee Burgamy c.s.r. 770-932-5927 extension 203
Emeline Gladden office administrator 770-932-5927 extension 204

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