The grace period for enrolling an employee after the employee becomes eligible for coverage varies with the carrier, but is typically 31 days.

The proper procedure for deleting an employee differs between carriers. Typically, termination of an employee involves either the submission of a change form or crossing him off the billing statement. We recommend sending change or termination forms to Hanson Benefits so that we may update our database and make sure the forms are complete before forwarding them to the carrier. Please be sure to include the employee's last date of employment on the form; the employee's coverage will continue through the end of the month that he/she was last employed. When dropping an employee from coverage, please also be sure to notify Hanson Benefits of the termination in a timely manner, in order to avoid issues with the carrier.

Whether or not a company is eligible to offer COBRA, an individual plan is an option that should be considered. Currently, Hanson Benefits is able to offer individual plans. Call Hanson Benefits for more information on what is available.

If you would like to find a PCP on your own, you may use a printed in-network provider directory, your insurance carrier's online directory, or speak directly to a customer service representative with your insurance company. If you have a specific doctor in mind, you could also ask that doctor or the doctor's billing representative whether he or she is a part of your insurance network, and what his/her provider ID number is. A word of caution: printed directories go out of date quickly and are generally not the best source for choosing a PCP, as PCPs will frequently join or leave the provider network in the middle of the plan year.

Once you have verified that your new PCP is a valid provider for your insurance plan and is accepting new patients, call the customer service number on the back of your insurance card to request a change to the new PCP. Some carriers will allow you to make this change yourself on their website.

The change in PCPs will sometimes be effective immediately, but generally does not go into effect until the first of the month following the date that you make the change. Check with your carrier to find out for certain when the change becomes effective.

You may also request enrollment forms directly from your carrier to be mailed to you. Some carriers also allow you to download enrollment forms directly from their website.

If the employee was not added recently but has not received an ID card, Hanson Benefits will be more than happy to find out why, make sure that the employee's coverage is showing accurately in the carrier's system, and request an ID card.

If the employee has misplaced the ID card, you may call the carrier directly to request a replacement card, or call Hanson Benefits to make the request for you.

If a policy number has not been issued yet for the group, or the employee information is not loaded in the carrier's billing system, the bill may have to be paid and a claim form submitted to be reimbursed by the carrier (submission of application is not a verification of coverage. The carrier must approve coverage for each employee before benefits will be available to that employee).

HMO plans do not generally have deductibles.

For a POS or managed care plan, a deductible will apply if you self-direct your care, choosing to see an in-network doctor without a referral from your PCP. The deductible will always apply for services or treatment received from out-of-network doctors. The deductible generally does not apply to a normal physician office visit with your PCP, but will apply to hospitalization, surgery and certain other types of outpatient treatments. For the most accurate information, consult your plan contract or call your carrier directly.

For a Preferred Provider Organization (PPO) plan, the information outlined above will apply, with the exception that you may self-direct your care and see any in-network physician without being subjected to the deductible. Certain types of treatments, however, such as hospitalization, surgery or treatment by an out-of-network doctor, may be subject to the deductible.

For those plans that include a deductible, the patient should be aware that, in general, an office visit to one's PCP or in-network physician will not be subject to the deductible. Also, if that doctor's office includes on-site x-ray and lab services, the copay for the office visit will generally cover these services as well. If the lab or x-ray services are not available in the doctor's office, the patient should be aware that these services would likely be billed separately and will be subject to the deductible.

Certain hospitals and ERs have contract agreements with specific insurance carriers. If your emergency is not life-threatening, you would be best advised to consult your insurance provider beforehand to make sure that you go to an in-network facility. If the emergency is life threatening, insurance carriers will generally make an exception and charge the visit at in-network rates regardless of whether the facility is in-network.

Emergencies and accidents that occur while traveling outside of your service area are usually covered at in-network benefit levels. Contact your customer service representative at the number on the back of your insurance card for more information on a case-by-case basis.

If the coverage is non-contributory and the employer also pays 100% of the cost for dependent coverage, then it is expected that all eligible dependents of all employees will also be enrolled in the coverage.

It is possible to decline non-contributory coverage if you have a valid reason for doing so. These reasons will vary by carriers. If you decline non-contributory coverage for yourself or your dependents without a valid reason and then try to join the plan at a later date, the carrier may reserve the right to penalize you by enrolling you in limited or "deferred" (late-entrant) benefits. If you have any questions about whether you or your dependents should be enrolled in your group's coverage, speak to your benefits administrator or call Hanson Benefits for more information.

If the employee was not added recently but has not received an ID card, Hanson Benefits will be more than happy to find out why, make sure that the employee's coverage is showing accurately in the carrier's system and request an ID card.

If the employee has misplaced the ID card, you may call the carrier directly to request a replacement card, or call Hanson Benefits to make the request for you.

If a policy number has not been issued yet for the group, or the employee information is not loaded in the carrier's billing system, the employee may need to pay the pharmacy for the prescription and submit a claim form to the insurance company to be reimbursed for the total amount of the prescription minus the co-payment. (Submission of application is not a verification of coverage. The carrier must approve coverage for each employee before benefits will be available to that employee.)

To use the Mail Order prescription program the employee must complete the carrier's Mail Order Prescription form and submit it along with the original prescription (not a photocopy) and a check for the amount of the prescription copay or credit card billing information. The prescription will be mailed directly to the employee's home or work address (whichever was specified by the employee on the order form). Mail Order forms may be available on the carrier's website or through the carrier's customer service department. When a refill is needed, the employee can simply make a call to the carrier's mail order department or sometimes go on line to obtain another 90-day supply. The refill can be charged to the credit card on file or the employee can be billed.

All Section 125 plans allow an employee to pay certain expenses (discussed in more detail below) on a pre-tax basis, thus reducing his or her taxable income.

Premium-Only plans simply allow employees to have their employers deduct the employee's portion of the insurance premiums directly from his or her paycheck before taxes are deducted from the paycheck. Hanson Benefits offers Premium-only plans at no cost to qualified employer groups.

Cafeteria plans will allow an employee to pay for premiums on a pre-tax basis, and also provide employees the opportunity to set aside an additional pre-established amount of money per plan year on a pre-tax basis in what is called a Flexible Spending Account (FSA). The money in the FSA can be claimed by the employee as he or she accrues medical or dependent daycare expenses (depending on which type of FSA the employee chooses), and will be used to reimburse the employee on a tax-free basis for those expenses. See the article entitled "Section 125 Cafeteria Plans" for further discussion.

If the company offers a Full Cafeteria plan, and an employee would like to enroll in a medical or dependent daycare FSA, the employee will also need to estimate what medical or daycare expenses will accrue during the course of the year. Based on that amount, the employee decides how much money he or she would like to contribute to the FSA on a pre-tax basis to cover those expenses. The employee should be careful not to overestimate these expenses, because the leftover amount will not be reimbursed at the end of the year. On the other hand, the employee may claim the full amount that he or she has agreed to contribute to the plan at any time, even if he/she has only contributed a portion of that amount at the time that it is claimed. If employment ends before the employee has contributed the full amount to the FSA, the employee does not "owe" the plan the remaining contributions. If employment ends mid-year, however, and the employee has not claimed the full amount that he or she has contributed to the FSA to that date, the employee will only be eligible to be reimbursed for expenses that accrued through the last date of employment.

Benefit premiums that are not paid for by the employer.

Medical expenses that are not reimbursed by your medical insurance such as co-pays, deductibles and coinsurance. Also, if your medical plan does not cover vision exams or hardware, chiropractic care, or similar treatments, these may be eligible for reimbursement under the Section 125 plan.

Qualified dependent care expenses, particularly when provided by licensed daycare professionals.