Products & Services >> Frequently Asked Questions

Banker Benefits - Frequently Asked Questions

Q: Do I need to ask a new employee for his/her Certificate of Creditable Coverage generated by the previous employer or plan?

A: No. Since the CBA-sponsored plans do not exclude coverage for pre-existing conditions, there is no need to obtain a Certificate of Creditable Coverage from a new employee. If Banker Benefits determines that a Certificate is required, you will be notified. Otherwise, please do not submit Certificates of Creditable Coverage with enrollment materials. Doing so will delay the enrollment process.

Q: Is there anything I need to do when I provide enrollment materials to an employee?

A: Until enrollment forms are revised, there is a special "Notice of Enrollment Rights" that you are to provide before or at the time an employee is offered the opportunity to enroll in a group health plan. This Notice can be printed on bank letterhead and must incorporate the following language:"NOTICE OF ENROLLMENT RIGHTS"

If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance coverage, you may in the future be able to enroll yourself or your dependents in this plan, provided that you request enrollment within 30 days after your other coverage ends. In addition, if you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you may be able to enroll yourself and your dependents, provided that you request enrollment within 30 days after the marriage, birth, adoption or placement for adoption.

Note: All banks must provide this notice.

Q: Will subscribers get ID cards for all coverages?

A: No, cards are issued for medical coverages and Delta PMI only.

Q: When will employees get detailed information about the plans?

A: As soon as Banker Benefits processes each enrollment, a packet will be sent to you for each newly eligible employee which will contain the following:

Employee Benefit Summary

Summary Plan Description Booklets for each coverage selected

A hand tote in which to keep all of your insurance booklets

Q: How can employees select a Primary Care Physician or check to see if their doctor is a participant in the plans?

A: The bank should keep a copy of each of the directories at each branch which can be used as a resource for employees who wish to enroll or change providers.

Q: How can an employee enrolled in CaliforniaCare change doctors?

A: The subscriber can call 800-301-4222 and request the change over the phone. DO NOT use the enrollment form for this purpose.

Q: How do employees enrolled in CaliforniaCare obtain authorizations to go to other doctors or specialists?

A: Such visits should be discussed with the Primary Care Physician, who has the responsibility of managing the care for subscribers. If the Primary Care Physician feels that the visit is medically necessary, he/she will provide an authorization.

Q: With a waiver letter, what is the effective date of insurance?

A: The insurance is effective the date the Enrollment Form is signed or the date of hire, whichever is later.

Q: What is the difference between open enrollment and Annual Transfer Period?

A: Open enrollment is when the bank brings the plan on for the first time and anyone can enroll or if the employee just becomes eligible. ATP allows switching between plans; it does not constitute an open enrollment (except for Kaiser, ATP is the only time for a late enrollee).

Q: Is a COBRA Qualifying Event Notice required if the employee does NOT have medical, dental, vision or EAP (Employee Assistance Program) coverage(s)?

A: Absolutely not. COBRA continuation coverage ONLY applies to health benefits as defined in the COBRA statutes, i.e., medical, prescription, dental, vision, and employee assistance programs. Therefore, do NOT complete a COBRA Qualifying Event Notice if the employee only has life, disability and/or accidental death & dismemberment coverage(s).

Q: Do I need to send a Cancellation Form and a Qualifying Event Form?

A: Yes. The Cancellation goes to the Service Representatives Unit and the Qualifying Event goes to the COBRA Unit.

Q: Can I send in a Qualifying Event Form when I know that an employee has filed for divorce?

A: No. Only send a Qualifying Event Form when the employee gets the final divorce decree.

Q: Do I send a COBRA Qualifying Event Form AND a Change Form when a dependent loses eligibility?

A: Yes. Both forms are required. The Qualifying Event Form must be completed and sent no later than 60 days following the dependent’s loss of eligibility, or COBRA cannot be offered to the dependent.

Q: Is a VOLUNTARY loss of coverage a COBRA qualifying event?

A: No. If the employee and/or dependent(s) remain eligible under the provisions of the Plan(s), and is VOLUNTARILY choosing to drop coverage(s), a COBRA qualifying event has NOT occured. Complete only a Cancellation Form or a Change Form as applicable; do NOT complete a COBRA Qualifying Event Form.

Q: If an employee terminates employment or retires, and is entitled to Medicare (i.e., is age 65 or older) upon the date of termination, is the employee eligible to continue MEDICAL coverage under the COBRA provisions?

A: No. If the employee is entitled to Medicare (age 65 or older) at date of termination or retirement, he/she may NOT continue COBRA medical coverage. He/she is eligible only to continue dental, vision, and/or employee assistance program coverages under the COBRA provisions. The maximum allowable COBRA period for the employee to continue dental, vision, or EAP coverages is 18 months.

The spouse or dependents that are under age 65 (if any), however, ARE eligible to continue medical AND dental, vision, and/or EAP coverages, for up to a maximum of 36 months from the termination/retirement date or from the date of the employee’s medicare entitlement, whichever is longer.

Q: May an employee/dependents elect to continue under COBRA only selected coverages, or must they continue all plans in which they were enrolled upon the date of the qualifying event?

A: An employee and each dependent may elelct COBRA coverage separately from each other if desired. An employee and each dependent may elect to continue any combination of plans in which they were enrolled prior to the qualifying event; e.g., they may elect medical only, or dental only, etc.

Q: When does Banker Benefits send COBRA information to the qualified beneficiary?

A: Banker Benefits MUST send the COBRA packet to the qualified beneficiary no later than 14 days after receiving the COBRA Qualifying Event Notice from the bank. It is, therefore, important that the bank provide us with the most current mailing address. Currently, our average turn-around time is 3 days.

Q: What are the COBRA rates?

A: Premiums are exactly what the bank is charged for the coverage(s) the employee was enrolled in while eligible for coverage at the bank, plus an additional 2% administrative fee. Once COBRA is elected, the qualified beneficiary is required to pay monthly premiums directly to Banker Benefits.

Q: My bank offers Small Group Blue Cross. When do the enrollment forms have to be signed?

A: Enrollment forms must be signed and dated within the 60 days prior to the effective date of coverage. Blue Cross will not accept enrollment forms signed and dated more than 60 days prior to the eligibility date.