10-A1 - 09.07.21Flores COBRA ImplementationGuide.pdf

COBRA 24/7

Implementation Guide

COBRA Administration Implementation Checklist

1. General Information

City of Burleson

141 W. Renfro Burleson, TX 76028

Deidre Hall Benefits Manager

817-426-9642

817-295-9414 dhall@burlesontx.com

HUB International 75-6000475

01/01/2022

None at this time

Medical, Dental & Vision

2. Plan Parameters

26 26 26

November 1 BenTek Already on File

ASK LORI??01/01/2022

Lori Lopez, UHC lori_k_lopez@uhc.com

Immediate 1 hour

48 hours 48 hours

Carrier/Rate Data Sheet

4. Health Plan Parameters

UHC

HD/HP HSA Plan

01/01/2022

248 as of 08/06/21 64 as of 08/06/21

UHC

EPO CoPay w/HRA Plan

01/01/2022 906435906435

44.42

155.16

84.76 238.16

87.98

457.54

303.56 734.35

Carrier/Rate Data Sheet

4. Health Plan Parameters(continued)

5. Acceptance Of Engagement

City Manager

COBRA Qualifying Event File Layout

The Insured File is composed of the following elements in a comma delimited ASCII file:

The Dependent File is composed of the following elements in a comma delimited ASCII file:

6. Pending Election File Layout

Social Security Number (9 characters. No hyphens) Last Name (maximum 20 characters) First Name (maximum 15 characters) Street Address Line 1 (Maximum 30 characters) Street Address Line 2 (Maximum 30 characters) City (Maximum 20 characters) State (2 character abbreviation) Zip Code (Maximum 10 characters) Phone Number (Maximum 13 characters) E-Mail Address (Maximum 50 characters) Birth Date (YYYY-MM-DD Format) Type of Event (One digit. See Event Type Codes) Date of Event (YYYY-MM-DD) Date Premiums Paid Through (YYYY-MM-DD)

Social Security Number of the Insured (9 characters. No hyphens) Dependent Number (1 numeric character. Each of the insured’s dependents must be numbered. The first Dependent would be one, the second two, etc.)

Dependent First name Dependent Last name Relation to the Insured (1 character. C – Child, S – Spouse, O – Other) Date of Birth (YYYY-MM-DD format)

The Election File is composed of the following elements in a comma delimited ASCII file:

Social Security Number of the Insured (9 characters. No hyphens) Dependent Number (0 for the subscriber, otherwise the same dependent number used in the dependent file) Plan Code Enrolled In (Each plan will have a different code. The codes used will have to be decided separatelyfrom this document.)

Monthly Premium (Values up to 9999.99. This is only needed for the Insured’s Record. It is ignored if completed for a dependent record)

6. Pending Election File Layout

Social Security Number (9 characters. No hyphens)

Last Name (maximum 20 characters)

First Name (maximum 15 characters)

Street Address Line 1 (Maximum 30 characters)

Street Address Line 2 (Maximum 30 characters)

City (Maximum 20 characters)State (2 character abbreviation)

Zip Code (Maximum 10 characters)

Phone Number (Maximum 13 characters)

E-Mail Address (Maximum 50 characters)

Birth Date (YYYY-MM-DD Format)

Type of Event (One digit. See Event Type Codes)

Date of Event (YYYY-MM-DD)

Date Letter Mailed (YYYY-MM-DD)

The Insured File is composed of the following elements in a comma delimited ASCII file:

COBRA Takeover File Layout

Date COBRA Coverage Began (YYYY-MM-DD)

If no letter has been mailed this should be 0000-00-00

If no response has been received this should be 0000-00-00

Date Premiums Paid Through (YYYY-MM-DD)

7. Active COBRA Takeover File Layout

Social Security Number of the Insured (9 characters. No hyphens)

Dependent Number (1 numeric character. Each of the insured’s dependents must be numbered. The first Dependent would be one, the second two, etc.)

Dependent First name

Dependent Last name

Relation to the Insured (1 character. C – Child, S – Spouse, O –

Other)

Date of Birth (YYYY-MM-DD format)

If no response has been received or no payments have been received. This should be 0000-00-00

COBRA Takeover File Layout

The Election File is composed of the following elements in a comma delimited ASCII file:

The Dependent File is composed of the following elements in a comma delimited ASCII file:

7. Active COBRA Takeover File Layout

APPENDIX B

Date COBRA Continuant Address Line City, State Zip

Dear COBRA Continuant:

Company Name has retained Flores & Associates to administer its COBRA continuation group health insurance program. Effective January 1st, 2016, Flores & Associates will be administering the record keeping, billing, and premium collection for your COBRA continuation coverage. Your payment for COBRA continuation coverage that is for January 2016 should be mailed to Flores & Associates.

Please remember that payment is due within the thirty-day grace period as required by COBRA.

Flores & Associates is located in Charlotte, NC. They have a Customer Service staff that can be reached toll free at 1-800-532-3327 between 8:30 a.m. and 5:00 p.m. Eastern Time, Monday through Friday. You can also access your account information via the web at www.cobra247.com for information concerning your COBRA benefits at anytime using the log-in instructions that will be included on your invoices.

The mailing address for Flores & Associates is as follows:

Flores & Associates PO Box 31397 Charlotte, NC 28231

You will receive an invoice for your January 2016 payment that will include payment instructions in APPROXIMATE DATE RANGE. Note that there is important information on both sides of the invoice.Please take a few minutes to read the material carefully. If you have any questions about the change in procedures, you can contact the Company Human Resources or Benefits Contact Information.

Do not mail your January COBRA payment to Name of the Previous COBRA Administrator.

Thank you, Human Resources Department

Steps for sending your announcement to current COBRA Continuants for the change in COBRA Administrators:

1. The attached WORD Document can be used as a model for your announcement to be printed on your company letterhead.

2. Date and address the letter accordingly.

3. Edit the following parts of the document to be printed on your company letterhead.

a. Company Name

b. Effective Date Information….Note that Date appears in 3 sentences

c. Approximate Date Range for receiving the first invoice from Flores

d. Company Human Resources or Benefits Contact Information

e. Name of the Previous COBRA Administrator

4. Edit the signature block to meet your needs.

5. We recommend keeping a proof of mailing for these letters. This may be a certificate of mailing; it does not need to be in the form of a certified letter.

APPENDIX C

A dministrator Website Orientation Guide www.flores247.com www.cobra247.com

How to enter COBRA Qualifying Events

The Enter COBRA QE page allows you to enter data for any participants that have experienced a Qualifying Event. Most often this function will be used for terminations, retirees, or anycovered individual that is no longer considered benefit eligible. COBRA Qualifying Events canalso occur due to divorce, a dependent aging out, or death of a covered employee.

Any information entered here will generate a Qualifying Event Notice that will be sent with a certificate of mailing to the eligible beneficiary, notifying them of their right to elect COBRA and the cost of each type of coverage.

You will notice four separate tabs in this section. After each step is complete, you will need to select the “Click to verify data and continue” to progress to the next screen. You can go back and forth between steps, but you will need to verify data each time you switch tabs.

The Personal and Event Info tab has required fields noted by an asterisk. If you enter an IDnumber that is already in our system, you will see the data from our database pre‐populate thefields listed. The Coverage Begins date will determine which plans will be available later underthe Benefits tab.

Please note: that in the case of a loss of coverage due to Divorce, Dependent aging out, and Death of the employee, you will need to enter the ID number, name, and address of the person who should be offered COBRA, not your employee, to be sure the notice is sent to the proper individual.

Steps for entering a COBRA QE:

Enter the SSN for the qualified beneficiary losing coverage. The SSN should be enteredas 9 digits without any dashes.

Groups that do not use SSN as the identifier should usetheir specific ID number with leading 0’s.

Enter the Event Date. This is the date the participant has terminated from coverage.

Please note the date should be entered as MM/DD/YYYY.

Enter the Event Type. Please select the reason for the loss of coverage.

Enter the COBRA Coverage Begins Date. This is the date the COBRA coverage should begin based on your plans specifications. It should either be the day following the event date or the first day of the month following the event date.

Please note this date should also be entered as MM/DD/YYYY.

A Premiums Paid Thru Date should only be entered if the full premiums will be covered for a specific amount of time.

In the example below, if the participant’s premiums weregoing to be covered by the employer through 02/28/2016, then this date could be entered into the Premiums Paid Thru box to indicate the participant should not be billed until 3/1/2016.

The Dependents tab will also pre‐populate with any dependents Flores has on file. If the names of all covered dependents do not pre‐populate, you will need to add their information to our system here.

Please enter as much data as you would like Flores to report for the individual’s dependents.

The Benefits tab is where you will select the Benefits the Participant and any eligible Dependents were enrolled in at the time of the COBRA Qualifying Event. Please keep in mind that if a dependent should be extended COBRA coverage, their name will need to be checked.The selections displayed on this screen will be your specific group health plans. If you find a COBRA plan is missing, please contact your dedicated Account Manager for assistance.

After all information is confirmed, finalize the entry by selecting, “Save COBRA Entry.” This information will also be included in the Friday reports that are emailed to you weekly (the Action Items and Weekly Recap) for your review. The confirmation tab will also notify you of any errors or fields that have not been correctly completed. You can only save the event once the errors have been resolved.

If your COBRA plan offers an employer subsidy because of a severance agreement, or if you have State Continuation plans that apply, please be sure to discuss this with your dedicated Account Manager to ensure these are being entered properly.

Once a QE has been entered you can search for the participant at the top of the webpage byusing their PID/SSN or last name.

On the participant overview section you can make edits to the participant’s personal data.

If you need to update a QE that has not printed you can select “Update” and make the change to the benefits selected, in additional to all other data that was input in the “Enter COBRA QE”Section.

In the Participant Overview screen you also have the ability to print a QE ahead of the regular printing schedule. As a reminder, all events entered by midnight on Thursday are mailed first class with a certificate of mailing the following Tuesday. If a situation arises where you need to hand deliver or send a letter ahead of that schedule, you have the ability to print the letter from this screen to obtain a copy for your records.

In addition, you can view all invoices, documents, and checks that come in and out of our officefor this participant. Since our office is a paperless office, all documents related to the participant are scanned as a digital image, and available for you to view.

How to enter a COBRA Initial Notice

The Enter COBRA Initial Notice page allows you to enter data for any participants that have recently become covered under a group health plan. Most often this is for new hires, but could also be used for a newly covered spouse of an employee, or an employee moving from part time to full‐time status.

Any information entered here will result in an Initial Notice being sent to the participant, which will notify him or her of their rights to COBRA continuation coverage, in the event a Qualifying Event occurs at a later date.

If you enter an ID number that is already in our system, you will see the data from our database pre‐populate the fields listed. You also will notice any COBRA initial notice mailing history atthe bottom of the page. If you wish to cancel an initial notice prior to Flores sending the mailing, you may do so by simply unchecking the “Send” fields, and then saving the entry.

As a reminder, all initial notices entered by Thursday at 11:59 PM EST will be sent out the following Tuesday.

Reports

Enter the date range for which you would like to view and select the desired report, including:

Active Participants: This report includes individuals that have elected coverage and are making payments. The report columns include the Participant Name, Dependent Name, Coverage Period, Monthly Cost, and COBRA Premium.

Pending Responses: The pending notices report will indicate Qualifying Event notices that are scheduled to be sent on the following Tuesday. Events entered by Thursday at 11:59PM EST will have notices generated the following Tuesday.

Payments Received: This report looks for the status of the COBRA payments that have beenreceived and will provide you with detail regarding actual payment history. The report columns include the Participant Name, Amount Paid, Date Received, Invoice #, Invoice Date, Invoice Period, Invoice Amount, and the Invoice Period.

Notices Mailed: This report looks for the status of qualifying event notices that have been mailed and will provide you with detail regarding outstanding election notices. The report columns include the Participant Name, Event Date, Event Type, Date of data entry, Date NoticeSent. Event Types include: Termination Voluntary or Involuntary, Reduction of Hours, Loss ofDependent Status, Medicare Entitlement, etc.

View Files

This page contains links to the files sent directly to carriers for updates if applicable. It also contains the link to the Friday COBRA reports you receive as the COBRA contact for yourcompany. You are able to view previously sent files from prior months by selecting the monthyou would like to view.

Flores & Associates, LLC 1218 South Church Street Charlotte, NC 28203

Phone: 704-335-8211 Fax: 704-335-0818