Post on 16-Aug-2015
Go Beyond Coping… and Conquer COBRA.
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Agenda1 COBRA: A quick primer
2 Liability is reality
3 There’s coping with COBRA…
4 …and there’s conquering COBRA
5 System Demonstration
6 DIY or Administrator?
7 What to look for in a COBRA Administrator
8 Questions
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COBRA: A quick primer
Why COBRA?
• Consolidated Omnibus Budget Reconciliation Act of 1985
• Requires employers who sponsor group health plans to allow individuals to continue coverage:• Qualifying events
• Limited time, at applicable rates
• Covered employees and qualified beneficiaries
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COBRA: A quick primer
• Health plan changes for current employees must also apply to former employees
• Required Notices:• General Notice of Continuation Coverage
• Election Notice
• Early Termination Notice
• Notice of Unavailability
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COBRA: A quick primer
Thanks to the ACA, there are now Fair Health Insurance Premium requirements:
• These individual or “member-level” rates are determined using:• Age
• Location
• Tobacco status of each family member
• Applies to individual and small group (<50) markets now
• Groups <100 employees: 1/1/2016
• Large groups >100 employees: 1/1/2017
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Liabilities are real
The penalties and liability with COBRA violations can be significantHere’s what happens if you don’t comply:
• $100 per day to the IRS for each day of non-compliance
• Excise taxes of $200 per day on each day the plan fails to comply with COBRA
• $110 per day to the beneficiary for each day of non-compliance
• Payment of claims incurred during non-compliance period
• Legal expenses
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Significant and constant notification and communication requirements.
Constantly coping with COBRA
Date of Hire•HIPAA Special Enrollment Rights
Commencement of Coverage•COBRA General Rights Notice
Qualifying Event•COBRA Election Notice
Other Notices•HIPAA Privacy Notice•Women’s Health and Cancer Rights
Ongoing•Monthly Premium Invoice•Notice of Unavailability•Conversion Notice•Termination Notice
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There’s coping with COBRA...
And there are more administrative duties, such as:
• Compliance
• Coordination with insurance carriers
• Eligibility tracking
• Payments
• Audits
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... And there’s conquering it
• Automation is key• Online, 24-7, real-time visibility
• Self service options for business:
• Add/terminate employees
• Review participant history
• Case monitoring and tracking of issues (in real time)
• Self service options for participants:
• Online payment of one or multiple premiums
• Advance payments
• Mobile App
• IVR
Make it easy on yourself.
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Conquering COBRA
Alleviate fear and uncertainty.
Transition assistance:
• Licensed benefit advisors ease fear and uncertainty of former employees
• Provide education to new COBRA enrollees
• Assist with transition from COBRA to individual or public options
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Conquering COBRA
Send COBRA election notices via USPS
Upload images of notices to website
Track election periods related to electing or declining continuation coverage
Report eligibility to carriers
Apply payments received to appropriate accounts and return payments that are not within COBRA guidelines
Answer questions from qualified beneficiaries
We do the hard work.
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Conquering COBRA
We also:
• Provide courtesy monthly invoices to all COBRA participants• Payments must be made by the end of the grace period or the
participant loses their COBRA rights
• EZ payment• Standard mail
• Over the phone
• Online
• Automatic withdrawal
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Conquering COBRA
When a COBRA coverage is terminated or cancelled, we:
• Send a termination letter to qualified beneficiaries, employer and carrier
• Notify of conversion or extension rights
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What to look for in a COBRA Administrator
Participant Advocacy
• Education• Notifications • Customer Service• Transition
Assistance
Performance
Guarantees & Indemnity
• Contractually agree to service standards
• Offer indemnity:Penalties, finesClaims, Excise taxes,Attorneys’ fees
Compliance & Security
• Security of all online data
• Election period tracking
• Record and store coverage, elections, and notifications
Comprehensive,
Flexible System
• Support ACA MLRs • Accommodate
custom severance, benefits packages
• Provide 24/7 online access
• Case tracking, reliable reports
• Flexible payment options
Choosing the right administratorKey questions to ask:
• Do you offer any performance guarantees?• Do you indemnify ?• Can you accommodate custom severance
packages?• Does your system enable brokers and employers
visibility and self-service options?• What types of reports are available to brokers and
employers?• Are participant notices available online?• How do you track premiums and payments?• What types of support and education do you provide to COBRA participants?• What are your service standards for COBRA participants, and how are they
monitored?• How do you support an audit?
Who is WageWorks?
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• Leading administrator of Consumer-Directed Benefits (CDBs)
• Servicing approx. 15,000 COBRA clients and 6 million participants
• Proprietary COBRA and CDB platforms
Questions?
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Thank you.
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