2015 BAW Conference

Enrollment Updates/HIPAA

Sabrina FreemanSue Sadik

Jason Simpson

October enrollment

• Enrollment options – effective January 1, 2016• Enroll in, change or cancel health coverage (can also add or

drop dependents)• Enroll in or cancel dental/Dental Plus (can also add or drop

dependents)• Enroll in or cancel vision (can also add or drop dependents)• Enroll in or increase Optional Life insurance by $50,000

without medical evidence (or cancel or decrease coverage)• Enroll in Supplemental Long Term Disability (SLTD), or

decrease waiting period• Enroll or re-enroll in MoneyPlus spending accounts

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October enrollment

• Important deadlines• Employee Benefits Services (EBS) will open for benefits

administrators (BAs) on September 15• MyBenefits will be open to subscribers on October 1 and

close October 31• All transactions on the BA console must be approved by

November 16• NOE’s and Barcode/Signature pages mailed to PEBA should

be postmarked by November 16• All supporting documentation for enrollment transactions

must be received by December 1

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October enrollment

• Please remember to update SLTD salary information• EBS will open on September 15 • Complete by October 31• PEBA will not accept late updates

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SLTD salary updates

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What’s new in 2016?

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Good news for your employees!

• Employee premiums will not increase for the fourth straight year!

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What’s new in 2016?

• Variable hour/full-time non-permanent employees will be eligible to enroll in all coverages available to permanent, full-time employees• Employee designations should be selected on NOE

or EBS• If current variable hour/full-time non-permanent

subscriber does not make any enrollment changes their Basic Life beneficiary will default to the estate

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What’s new in 2016?

• Variable hour/full-time non-permanent employees should be treated as new hires for Optional Life insurance purposes• Variable hour/full-time non-permanent

employees currently being covered by Dependent Life Spouse will need to be dropped

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What’s new in 2016?

• Employees are no longer required to have completed one year of continuous state-covered service by January 1 to enroll in a medical spending account• WageWorks will allow electronic enrollment for any

first time participants• All participants in a medical spending account will

receive a debit/credit card, and there will be no fee

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What’s new in 2016?

• TRICARE Supplement subscribers will be eligible for Basic Long Term Disability and Basic Life insurance• If subscriber does not make any enrollment changes their

beneficiary will default to estate

• Dependent Care Spending Account will be capped at $1,500 for highly compensated employees.• Internal Revenue Code defines a highly compensated

employee as someone who earned $120,000 or more in calendar year 2015.

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What’s new in 2016?

• Ex-spouse coverage is not eligible for pre-tax premiums. • Employee covering an ex-spouse on any benefit will

not be eligible for pre-tax treatment of premiums. • Does not affect the member’s eligibility to participate

in a medical spending account or dependent care spending account.

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Update your contacts via EBS

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Helpful tips

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When possible, use EBS

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When possible, use EBS

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When possible, use EBS

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New hires

• New hire NOE or Active Benefits Refusal form• send for each employee in a benefits-eligible position• send even if employee refuses coverage • assists in Special Eligibility Situations

• Use Active Benefits Refusal forms only for:• dependents under age 26 wishing to remain on parent’s

coverage, and they will be refusing all benefits as a subscriber such as Life Insurance and Long Term Disability

• Non-Medicare eligible retirees who have returned to work

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New hires and other changes

• Send NOEs and SOEs/SOCs• when complete and with all the required documentation• incomplete form or missing documentation results in

rejections

• Coverage is activated• when transaction completed• subscriber has signed within the allowed time

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New hires and other changes

• For new hires and employees making changes during open enrollment• verify coverage and/or changes before making doctor

appointments or getting prescriptions filled• received card, review MyBenefits, contact vendor

• Defining “medical emergencies”• Contact Call Center• Paper NOE’s not accepted

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Rejections

• Clearing rejections in a timely manner is important to assist your employees and dependents as well as ACA reporting purposes.• Pending or rejected transactions in EBS• delete transaction before “correcting” it by sending in a

paper NOE• include all required documentation; or• reapprove the transaction and resend barcode with

required documentation.

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Rejections and suspense

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Suspense

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Rejections

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Rejections

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Documentation

• It is helpful for you to put an asterisk or star by the effective date or other pertinent information on documentation.

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Requests for review• A Request for Review may be submitted either by

subscriber request or due to a clerical error/delay.• explain what the situation is and any contributing factors

that caused the delay or error• include NOE with the requested change• include all necessary paperwork and documentation

• dependent documentation• loss/gain of coverage letters

• maximum one year retro• retro premiums will apply for retro coverage• it is helpful to indicate if the subscriber has been paying premiums

or at least they are aware they will be due

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Requests for review – eligibility appeals• If request for review is denied:• only subscriber may appeal within 90 days• request for review has 90 day language with address• appeals are legal process and takes time to complete

• If appeal is denied• subscriber may seek judicial review by filing a case at the

Administrative Law Court

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Assisting retirees

• Terminate new retiree’s active coverage as soon as paperwork is complete• Remember, it is easier to terminate coverage through

EBS• Quickly terminating your retiring employees’ active

coverage will help your former coworkers avoid inconveniences

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Questions

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Security

• EBS no longer automatically refreshes.• The BIN replaces SSN on Summary of Enrollments and

Summary of Changes (SOE and SOC).• Dependents and beneficiaries SSN have the first 5

digits as “X” and appear as XXX-XX-1234.• PEBA redacts any Social Security numbers before

sending paperwork or correspondence.

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Security and privacy reminders

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• Name• Five digit ZIP codes• Dates related to an

individual: • DOB • admit• discharge• DOD• all ages over 89

• Telephone numbers• Fax numbers• Electronic mail

addresses• Social Security numbers• Medical record

numbers• Health plan beneficiary

numbers• Account numbers

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Protected health information (PHI)

• Certificate/license numbers• Vehicle identifiers and

serial numbers, including license plate numbers• Device identifiers and

serial numbers• Web Universal

Resource Locators (URLs)

• Internet Protocol address numbers (IPs)• Biometric identifiers,

including finger and voice prints• Full face photographic

images and comparable images• Any other unique

identifying number, characteristic or code

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Protected health information (PHI)

Workstation use and security

• Access of PHI without subscriber authorization must be limited to purposes permitted

• Staff shall not load unauthorized software, programs or files onto their workstations

• Staff shall not copy records onto personal devices• Monitors should be positioned such that

unauthorized persons cannot view information

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Workstation use and security

• Do not share your password with anyone. This includes IT and your supervisor. Additionally, do not write your password on sticky notes or other paper and leave it around or near your computer.

• Do not use someone else’s account or spoof or send emails that appear to have originated from one source when actually they were sent by another source.

• Staff must lock their workstations when leaving work area for extended periods.

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Email and malicious software

• Do not open emails unless you know the sender. If you receive email from an unknown sender, contact IT.

• Please inspect email addresses carefully to ensure they are from a legitimate source.

• Do not open links in emails without confirming with the sender the validity of the links.

• Do not give your work email address for any personal emails.

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Email and malicious software

• Never download files from the Internet.• Never install any personal software on your

computer.• Do not make illegal copies of any software.• Notify your supervisor if you suspect your password

has been compromised.

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Logins

• Immediately report any of the following to your supervisor:• If someone is using another’s password• If someone is asking for your password• If your screen suddenly looks different• If there is any other unusual or out-of-the ordinary

situation• Don’t login from a free Wi-Fi connection

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Transmissions

• Every effort will be made to avoid or limit the transmission of PHI via electronic means (e.g. faxing or emailing); and then, only with the proper protocols and disclaimers in place.

• Any documents to be sent via fax should be sent via electronic fax, if possible. If not possible, the sender must remain at the machine until the transmission is complete to remove material from the machine.

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Transmissions

• Fax machines and copiers should also be regularly checked for, and cleared of, material containing PHI.

• Emails containing PHI should be sent using the encrypted secure email function. Avoid full SSN whenever possible especially if you don’t have encrypted email.

• Documents containing PHI must be placed in the locked shred bins.

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Transmissions

•No materials containing PHI may be left on photocopiers, fax machines or exposed on any work area. • Telephones, voicemail and answering machines are

not secure. Don’t discuss PHI over speakerphone and do not leave messages containing PHI on an answering machine.• Be certain that you are talking to the subscriber or

their authorized representative when giving subscriber information over the phone, just as if you were providing the information in person.

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Physical security safeguards

• Employees must clear desks and workspaces of any sensitive documents or PHI at the end of each workday and place these documents in a secure location to prevent inadvertent disclosure.

• All unsecured areas (desks, work areas, faxes, copiers, etc.) should be cleared of all documents containing PHI when not in use.

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Questions

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Disclaimer

This presentation does not constitute a comprehensive or binding representation regarding the employee benefits offered by the South Carolina Public Employee Benefit Authority (PEBA). The terms and conditions of the retirement and insurance benefit plans offered by PEBA are set out in the applicable statutes and plan documents and are subject to change. Please contact PEBA for the most current information. The language used in this presentation does not create any contractual rights or entitlements for any person.

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