Frequently Asked Questions

Employee Questions:

Q: How do I know when my benefits will start?
A: Your Employer has selected a benefit waiting period to determine when your benefits will begin.  Please check with your Employer or H.R. person to verify when your benefits will start.

Q: I received a bill from a provider that seems higher then I should pay.  How do I know if the amount due is really my responsibility?
A: First obtain a copy of your Explanation of Benefits (EOB) from the insurance company.  These are usually mailed to you or you can print them online.  If the amount looks different from what the provider is charging you, you may want to call your provider and ask for an explanation on why the amounts do not match.  If the bill or claim still seems incorrect please contact Benefits by Design for further assistance. 

Q: Can I join the insurance at anytime throughout the year?
A: You can only come onto an insurance plan if you are a new hire who just met their waiting period, if it is Open Enrollment time for your group or if you have a Qualifying Event?

Q: What is a Qualifying Event?
A: A Qualifying Event is also referred to a Life Changing Event.  Examples of these events would be:  Getting Married, Getting Divorce, Having a Child, Adopting a Child or Loss of prior coverage.

Q: We just had a new baby.  How long do we have before we have to add the baby onto the plan?
A: You must add the baby on within 31 days of the baby’s birth date.  Failure to do this would result in having to wait until Open Enrollment before the baby can be added again.

Q: Do I need a referral to see a Specialist?
A: If you’re on a PPO based plan then you do not need a referral to see a Specialist.  However, if you’re on an HMO based plan you would need to see your Primary Care doctor first and then have them give you a referral to a Specialist. 

Q: What is a deductible?  How does it work? 
A: A deductible is a set dollar amount that you will pay towards specific services that are not typically covered by a copay.  You will pay your deductible then coinsurance which is generally 20% (but will vary depending on plan) of the remaining balance, up to the max out of pocket limit.  Copays do not apply towards deductible.

Q:  What is co-insurance? 
A: Co-Insurance applies after the deductible is met on specific services.  You will split a % with the insurance company.  Generally the insurance company pays 80% you pay 20% of the remaining balance up to a max out of pocket limit once your deductible is met however the % can vary depending on the plan type.

Q: Why is Cobra coverage so expensive?
A: Cobra is the same rate that your company was being charged for your coverage with your employer which includes the amount that you might have been contributing.  The only price difference that can be added is 2% for administrative costs.

Employer Questions:

Q: How do I add or remove an employee from our policy?
A: You can send your request directly to Benefits by Design and we will process the change for you.  We will even follow-up with you to let you know once it has been completed.  Please note that different carriers could require you to submit the form prior to the cancel date of coverage.

Q: I have an employee that no longer wants benefits.  Do they have to wait until Open Enrollment to drop their benefits?
A: Employees and also dependents can come off the plan at anytime during the year.  However, they will have to wait until Open Enrollment of next year if they want to sign up for coverage again.

Q: Do I have to offer COBRA coverage to employees that no longer work here?
A: The Department of Labor requires that Employers who had an average of 20 or more employees the majority of the prior year need to offer COBRA benefits to their terminated employees. 

Q: How much of the Employee only premium does our company have to pay for in order to offer Group Coverage?
A: The Company must pay a minimum of 50% of the employee only premium and 0% of the dependent premium in order to offer a group plan.

Q: I have an Employee who lost their id card.  How do I order them another card?
A:Employees can contact the insurance company directly or can go online to the carrier’s website to request a new id card. 

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