Employers

Group Administrator's Manual

Frequently Asked Questions

Listed below are some of the most frequently asked questions asked of our group service representatives. Please feel free to call us with any questions. However, you may want to refer to these questions and answers for certain information.

Q. Do new employees have to complete the medical questionnaire on the application?
A. New hires in groups with 2-50 employees must always complete the medical questionnaire on the application. New hires in groups with 51 or more employees must complete the medical questionnaire only if they are a late enrollee.

Q. If an employee is on disability leave, how long can the employee be covered on the group plan?
A. The maximum period of time an employee on disability can be covered through the group is six months. At the end of the six months, the employee would have the following options:

  • Return to work;
  • State of Arkansas 120-day continuation policy;
  • Convert to COBRA, if applicable; or
  • Drop coverage.

Q. I have an employee who was canceled from our group by mistake. How do I add them to the group again?
A. Contact your group service representative within 30 days of cancellation, and request that the employee be added back to the group coverage. The underwriting department may require payroll records to prove continuous coverage.

Q. Can an Arkansas Blue Cross member transfer from one group into another group with continuous coverage?
A. An employee may transfer from one group into another group with time credit. A 12-month pre-existing condition exclusion period will be applied to that employee; however, creditable coverage from the prior group will be applied against that exclusion period. If that creditable coverage is 12 months or more, the pre-existing condition exclusion period would not apply.

Q. How does an employee obtain a Certificate of Creditable Coverage upon termination?
A. A Certificate of Creditable Coverage will be automatically generated and mailed to the last known address of the employee.

Each group was mailed a generic form of the Benefit Plan Certificate of Coverage. You, as the group administrator, may complete a copy of this form and present it to the terminated employee at the time of termination or at the exit interview.

Q. Do BluesEnroll groups have an open enrollment at the time of our anniversary?
A. Yes. Employees who wish to be added to your group health insurance program or who want to make changes to their coverage can do so during their open enrollment period.

Q. Do you have continuous coverage if you transfer from a group policy to the Arkansas Blue Cross conversion policy?
A. Yes. Arkansas Blue Cross’ conversion policy requires no medical underwriting.

Q. An employee soon will be getting married. When can the employee change to family coverage?
A. If an employee marries, an application must be received within 30 days of the marriage to be considered a timely addition. The new spouse will be added to the group policy effective at the first of the month of following the date of the marriage. The spouse that is considered a timely addition is subject to a 12-month pre-existing condition exclusion period that may be offset by prior creditable coverage. A copy of the marriage license will be required.

Q. An employee just found out that she is pregnant. When should she change from an individual policy to a family policy?
A. The employee should change from single to family coverage within 90 days of the birth for the application to be considered timely.

Q. An employee has a family policy and needs to add a dependent. What do they need to do?
A. Please see "New Enrollments or Changes Due to Special Events" in the "Group Coverage Guidelines" section.

Q. An employee would like to change a policy from family to individual. When will the change be effective?
A. The change will be reflected on the next billing cycle, after approval of the change request form.

Q. We have a new employee who has had other insurance that was not group coverage. Will the employee have creditable coverage from that insurance?
A. As defined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), individuals who have any of the following types of health care plans will be entitled to transferable creditable coverage:

  1. Other group health plans (including COBRA)
  2. Individual Major Medical coverage
  3. Medicare Part A or B
  4. Medicaid
  5. Tricare
  6. Federal Employees Health Benefit Plan (FEHBP)
  7. Medical care programs of Indian Health Services or tribal organizations
  8. State health benefits risk pools
  9. Public health plans
  10. Peace Corps health plan

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