Employers

Frequently Asked Questions

How do I enroll a new employee for coverage?

In order to be a "timely enrollee," most plans require an employee to enroll as soon as eligible. Generally, Significa Benefit Services must receive a properly completed enrollment form no later than 30 days from the date the employee satisfies the waiting period.

Refer to the "Eligibility" section of your plan document for specific requirements regarding timely enrollment provisions.


Does an enrollment form have to be completed for a new employee who has decided to waive coverage?

Yes. A new employee who decides to waive coverage when initially eligible should complete an enrollment form and return it to Significa Benefit Services. A properly completed enrollment form (and signed waiver) must be on file if the employee wishes to enroll at a later date under "Special Enrollment" circumstances.


What happens if an enrollment is submitted "late?"

Many plans do not permit enrollment outside the annual open enrollment period. If that is the case, the employee or dependent must wait until the plan's next open enrollment period to enroll. However, if the employee or dependent experiences a special enrollment event prior to the next open enrollment period, he/she may have an opportunity to enroll earlier.

Which enrollment form should I use?

Self-Funded plans may use Significa Benefit Services' "Self-Funded Group Enrollment Form" for all types of enrollments, including timely new hires, dependent enrollments, late enrollments, open enrollments, special enrollments and reinstatements. This form can be downloaded from the Significa Benefit Services web site. See S/F Enrollment Form. Self-Funded plans also have the option of enrolling new employees or changing current employee information online.


Are newborns automatically covered under the plan?

Newborn enrollment requirements vary, but most plans require enrollment of newborns within 31 days of birth. Please consult the "Special Enrollment" provisions in your plan document for your plan's specific requirements.


What form is used to add a dependent for coverage?

Self-Funded plans may use Significa Benefit Services' "Self-Funded Group Enrollment Form" for all types of enrollments, including all dependent enrollments. This form can be downloaded or enrollment can be made from the Significa Benefit Services web site. See S/F Enrollment Form.


What is a "Special Enrollment Period?"

Group health plans are required to provide special enrollment periods during which individuals that previously declined coverage for themselves and their dependents may be allowed to enroll without being treated as late entrants. These circumstances include:

(1) Loss of eligibility for coverage under a group health plan or other health insurance coverage due to specific loss of eligibility events or when an employer terminates contributions toward health coverage;

(2) Acquisition of a new dependent through marriage, birth, adoption or placement for adoption;

(3) Loss of eligibility for coverage under Medicaid or the Children’s Health Insurance Program (CHIP); and

(4) Becoming eligible for a premium assistance subsidy under Medicaid or CHIP.

Along with a completed enrollment form, acceptable proof of the special enrollment event must be provided with the enrollment. For events 1 and 2 above, the submission must generally be received by Significa Benefit Services within 30 days (or any longer period that applies under the plan) of the special enrollment event. For events 3 and 4 above, the submission must generally be received by Significa Benefit Services within 60 days of the event.

Refer to the eligibility section of your plan or policy for a full description of your special enrollment rights or contact our Policy Administration Department with questions.


What documentation must be submitted to reduce the length of a pre-existing condition exclusion period?

The pre-existing condition exclusion period can be reduced by applying previous creditable coverage. Any credit applied is subject to verification and receipt of required proof.

The most common proof of previous coverage is a Certificate of Creditable Coverage (CCC). A CCC can be requested from the employee’s previous benefit plan and submitted to our Policy Administration Department for review. (Include the Employee’s Name and Social Security Number on the CCC.) CCC can be emailed to poladmin@significabenefits.com.


What status changes must be reported to Significa Benefit Services?

An Employee Change/Termination Form can be downloaded from our web site and should be used to notify us of most status changes. Terminations can also be submitted online by the employer. Status changes include:

  • Name and address changes
  • Life insurance beneficiary changes (Employee signature is required)
  • Waivers of coverage (Employee signature is required)
    Employees and/or dependents who are already on the plan and who now wish to discontinue their coverage must notify Significa Benefit Services.
  • Employee status change (Class, position, salary)
    If an employee's class, position or salary is used to determine the level of their benefits, notify Significa Benefit Services of the change. For example, disability income benefits and life insurance may be affected by a change in salary.
  • FMLA Leave
  • Terminations of coverage for any reason, including but not limited to:
    • Termination of employment
    • Reduced hours
    • Lay-off
    • Approved leave of absence
    • Disability
    • Retirement
    • Divorce
    • Child dependent turning age 19
    • Child dependent over age 19 no longer a full time student

    Notify Significa Benefit Services immediately upon termination.

When does an employee's or dependent’s coverage terminate?

An employee's or dependent's coverage will terminate when they cease to satisfy the eligibility requirements as set forth in the plan. Examples of this may include:

  • Termination of active full-time employment for any reason
  • Reduction of hours (full-time hours reduced to part-time)
  • Child dependent reaches the maximum dependent age
  • Divorce (applies to spouses and step-children of the employee)
  • Employee does not return to full-time work after FMLA leave

Refer to the "Eligibility" section of your plan for a full description of termination events.


What is the COBRA election process?

An employer that is subject to COBRA as defined by federal regulations must notify Significa Benefit Services within 30 days that an employee’s coverage has terminated.

  • Within 14 days of being notified by the employer that an employee’s coverage has terminated, Significa Benefit Services will mail a COBRA notice and election form to qualified beneficiaries.
  • To Elect COBRA, the qualified beneficiary must complete the election form and return it to Significa Benefit Services within 60 days.
  • Upon receipt of the election form, Significa Benefit Services will mail the first premium invoice to the qualified beneficiary. The full initial payment must be received by Significa Benefit Services within 45 days.
  • Coverage is reinstated when Significa Benefit Services receives the first full premium payment.

When are Cobra participants billed and payments due?

Cobra participants are invoiced monthly. Payment is due by the date listed on the invoice. A 30 day grace period is available, however, payments received after the grace period will not be accepted. This will result in termination of Cobra coverage.


Does Significa Benefit Services verify domestic partner eligibility if covered under our plan?

Yes, at the time of initial enrollment and annually thereafter, Significa will request the domestic partner complete the Affidavit to confirm eligibility under the plan.


Why does Significa ask me to provide information about certain employee's work hours?

As your TPA, Significa continuously reviews data/information to assure the eligibility of covered members before a claim is reimbursed. As such, we may ask to verify the working status of a specific employee to assure they meet the eligibility as outlined in your plan.


When can my employees make changes to their PPO election?

An employee can generally change PPO elections at open enrollment. If the plan does not offer open enrollment, the employee can request a prospective change to PPO election due to change in address, for example, the employee has moved out of current PPO service area for example.


My employee wants to know why Significa does not call them when they deny a claim. How do you notify employees of a denial?

Your plan contains a claim procedure provision. As such, Significa has a specified period of time to review and adjudicate a claim. Post service claims must be denied within 30 days. Denials are required to be issued in writing. Many times, a denial is not a final determination.

To assure we properly and correctly adjudicate claims we request information such as other coverage information, accident details or medical documentation in order to proceed with our evaluation and final determination of the claim. Most of these requests are issued on the Explanation of Benefit (EOB) and are sent to both the provider and employee.

A prompt response to these requests allows Significa to complete the claim process.