UnitedHealthcare is supporting its fully insured and self-funded customers (all segments) by allowing a Special One-Time Enrollment Opportunity to enroll employees who previously failed to enroll in coverage. The opportunity will be limited to employees and their dependents who waived coverage at the time when they were first eligible for coverage under customer’s plan.
Under the Affordable Care Act, all individuals must have minimum essential coverage (MEC) or they may be subject to the shared responsibility payment in 2014. The new law contains a number of exemptions from the MEC requirement addressing, for example, individuals without access to affordable coverage, members of certain religious sects, as well as individuals who experience a short coverage gap.
The Department of Health and Human Services (HHS) has also created an additional shared responsibility payment exemption for individuals who enroll in an Exchange plan any time prior to the close of the initial open enrollment period.
In addition, special rules apply to individuals who are eligible to enroll in non-calendar year plans from their employer. These individuals will not be liable for the payment until after the month in which their 2013-2014 plan year ends.
Employees who previously elected self-only coverage will be able to change their election to include coverage of eligible dependents as long as they are enrolled in the same coverage or benefit option as the employee. This is not an open enrollment period where all covered employees may change a benefit election.
This Special One-Time Enrollment period runs from Nov. 1, 2013 to Dec. 31, 2013 for all fully insured customers. Coverage will be effective as of Jan. 1, 2014. Self-funded employers may establish their own criteria. During this period, employers may not add new plans.
Small Groups
- Existing eligibility and state guidelines will apply. For small employers (1-50), a current wage and tax statement will be needed to validate the employee’s eligibility for UnitedHealthcare. Oxford plans will not require a wage and tax form.
- For all groups 1-50 and for all platforms, eligible dependents can be added if the employee is enrolled without a wage and tax statement. Here is the process:
- The group will submit to its Health Plan contact the following required documents:
- Group’s current policy number
- Employee applications
- Product selection and medical plan for each member being added
- Current wage and tax documentation for employees being added (not required for Oxford)
- The Health Plan will submit the group to the designated platform e-mailbox with a subject line of “Special Enrollment.” Oxford will follow the standard enrollment process.
- The documents then will go to Case Installation for processing. Groups will be tracked manually. A new Policy & Procedure (titled Individual Mandate Special Enrollment) provides direction on the entire process. (Posted in the Knowledge Library)
Large employer groups (51+)
- Should follow their standard eligibility submission process. Those groups with more than a 20% change in census will be re-rated.
- Employer e Services is not available for this one-time enrollment.
Special Notes:
- Non-calendar year customers are not required to allow thisSpecial One-Time Enrollment Opportunity, but this is an option for those who wish to do so. Customers should make their own determination.
- UnitedHealthcare will provide a sample “Notice of Special One-Time Enrollment Opportunity” to be used by our customers to inform employees of this unique opportunity to enroll in their group health plan. Customers wishing to offer this enrollment opportunity should complete the Notice and distribute it to employees who are eligible for coverage under the plan.
- There will be no need to formally amend the plan. Employers may use the “Notice of Special One-Time Enrollment Opportunity” to function as a plan amendment.
- Employers may amend their cafeteria plans to allow for changes in benefit elections to coordinate with this enrollment opportunity as they deem appropriate. We recommend that customers speak with their benefits counsel or tax advisor for more information about cafeteria plan changes.
- There will be no need to formally amend the plan. Employers may use the “Notice of Special One-Time Enrollment Opportunity” to function as a plan amendment.
- Employers may amend their cafeteria plans to allow for changes in benefit elections to coordinate with this enrollment opportunity as they deem appropriate. We recommend that customers speak with their benefits counsel or tax advisor for more information about cafeteria plan changes.