Healthcare Coverage Enrollment and Eligibility– As an Agency employer you are responsible for calculating healthcare coverage eligibility and processing enrollment for all of your employees. 

Agency employer responsibilities: 

• Collect and report service hours to BSI for your employees no later than the 20^th of each month for the previous month.
• When a member becomes initially eligible for healthcare coverage through the trust, send an enrollment applications to member to complete.
• Send completed enrollment application forms to BSI for processing.
• For actively, ongoing eligible employees identify and deduct co-premiums from payroll for healthcare coverage.
• Notify BSI in writing if employee has been terminated from employment so a COBRA notice can be sent to the employee.

As of August 1, 2015, the hours requirement changed to 80 services hours per month. 

Gap Coverage Grant –The Health Benefits Trust is pleased to offer a one-time grant to actively enrolled health plan members whose hours drop below 80 compensable hours for one month but remain above 60 compensable hours for that same month.

• A member is eligible to apply for one month of coverage once within a plan year (August 1, 2015-July 31, 2016).
• The Health Coverage grant will be awarded on a first come first served basis for eligible Home Care Aides until the pilot fund is depleted.
• Members are able to combine their compensable hours from multiple employers to meet the 60 hour requirement.
• If one of your employees would like to receive a Coverage Grant, an application is available on the myseiubenefits.com website, in the Your Benefits booklet and/or BSI can provide a form. 
• The employee provider is responsible for providing a self-payment for the $25 monthly co-premium by the 10th day of the month in which they are requesting coverage.
• The Health Coverage grant does not cover family members or dependents. 
• Once the application and payment are received the employee will receive confirmation that their coverage grant is approved.
• They will be able to continue to use their regular health insurance card and will have access to the same health benefits as when they are regularly enrolled in the plan.

Automated Coverage Re-Instatement for Active Participants – If your employee loses HBT coverage for a period of time that is less than 12 months, they will not have to reapply for coverage (as long as we have a current signed enrollment form on file). Their coverage will be automatically reinstated once hours reach 80 or more again. Please be advised, members who are without HBT coverage for 12 or more consecutive months, have to requalify for healthcare benefits by meeting the initial eligibility requirements again. A new enrollment form will need to be completed and submitted to HBT.

Effective: August 2015

• Initial Eligibility – Coverage is not automatic. An employee provider will need to have a current signed enrollment form requesting HBT coverage on file.
• Temp. Reduction in Hours:  After August 1, 2015, if there is a temporary reduction in hours a termination form is no longer required for employee providers if we have a current signed enrollment form on file.
• Terminated Employee – If an employee is no longer employed by an Agency, a termination notice is required by the Agency employer for each terminated employee provider.
• Re-Hired Employee – If employment is re-instated a new signed enrollment form requesting HBT coverage will be required if and when the employee is eligible for coverage based on the Trust policies.
• Reporting – Agency employers have access to an online tool to view which employees have active coverage each month and which employees lost coverage due to a reduction of hours.
• FMLA – Notification of FMLA is still required to be sent by Agency employer.
• Waived Coverage – If an employee provider would like to waive their coverage, Agency employer will need to send in a signed waived coverage form for that provider.

HBT News (Employers can access detailed information by clicking on the provided link)

Grandfather Status Eliminated – As of August 1, 2015, the grandfathered status has been eliminated. Anytime an HBT member loses coverage due to reduction of hours or termination of employment or for various other reasons, upon their reinstatement onto the HBT plan, they will no longer be subject to the grandfathered rules. Standard eligibility and enrollment policy and procedures will apply to member going forward.

Combined Hours

• Is a program that allows IP/APs who work 80 or more hours per month combined, to receive HBT coverage.
• This program is administered by BSI.
• BSI sends a letter to eligible members when it’s determined that they meet the eligibility criteria.
• Upon receipt of the application and $25 co-premium payment, IP/APs are provided with HBT coverage.
• Once coverage is reinstated, members will have access to the same health benefits as when they were regularly enrolled in the plan.
• Reports listing these members are available to employers upon request.

Switching Dental Carriers – HBT members may request a one-time switch from their dental plan carrier once per plan year. If you have employees interested in making this switch, please have them contact The Member Resource Center (866-371-3200) for more information.

FMLA Coverage – Agency Employers shall provide eligible employees’ health care coverage for up to 12 weeks when employees are out of work for various reasons.

Agency employer responsibilities: 

1. Notify BSI in writing when an employee is on FMLA (Please provide Full Name, SSN, Start and End date of FMLA Leave). 
2. If end date is not available at the start of the leave when the employee returns to work please notify BSI.
3. Provide employees with coverage effective and term dates.
4. Notify BSI if employee does not return to work and has been terminated from employment. 
5. A COBRA notice will be sent to the employee.

Due to the Trust’s eligibility policy identifying when coverage starts and ends can be confusing. The following is a chart to help guide coverage eligibility for members who were on FMLA leave. 

MEDICARE PART D “Credible Coverage” – Medicare offers insurance coverage to its beneficiaries for prescription drugs.  This is referred to as Medicare Part D coverage.  Medicare Part D eligible individuals must be advised whether their employer sponsored prescription drug coverage is considered creditable coverage – i.e. if it is as good as or better than Medicare Part D coverage.  These disclosure notices must be provided at the following times:

• Annually prior to the Medicare Part D coordinated election period (October 15^th – December 7^th).
• Prior to a newly eligible Medicare Part D participant’s initial enrollment period for Medicare Part D.
• Prior to the effective date of coverage for any Medicare Part D eligible individual who comes on to your group health plan.
• Whenever you no longer offer prescription drug coverage or the status of your prescription drug coverage changes (i.e. from creditable to non-creditable or vice versa).
• Upon request.

Medical carriers have determined that the prescription drug coverage offered through the SEIU 775 Health Benefits Trust does meet the requirements to be considered creditable coverage. 

Benefit Solutions, Inc. has mailed the creditable coverage notice to all of your plan participants.  By providing a notice to all plan participants, it satisfies #1 and #2 above, and ensures that all required participants receive the notice (as it is not easily known who is, or will become, Medicare Part D eligible for reasons other than attaining age 65). 

ACTION REQUIRED:  Please provide a copy of the applicable notice to any newly hired employees and newly eligible participants prior to their effective date of coverage. This will satisfy #3 above.

For guidance on the acceptable manner and methods of distribution to participants, please see pages 12 and 13 in the following CMS Guidance document: https://www.cms.gov/Medicare/Prescription-Drug-Coverage/CreditableCoverage/downloads/Updated_Guidance_09_18_09.pdf.