Frequently Asked Questions

Answers to Frequently Asked Questions

Our client’s dedicated VistaNational Account Managers and Account Executives receive questions every day. Read below for some of the Frequently Asked Questions along with answers. If you have a question that isn’t addressed, don’t hesitate contacting us for a quick and accurate answer from one of our professionals.

Q1: Sally covers her children on her plan and her spouse also covers the children through his employer’s plan. How does this work and which plan would pay first?

A1: Determining the order of coordination of benefits requires “the birthday rule.” Because both parents are insuring the children, the parent’s birthday that falls first in the year would be primary. Sally’s birthday is July 5th and her spouse’s birthday is March 15th. Her spouse’s plan would be primary for the children.

Q2: Can my employee have an HSA account and an FSA account open and active at the same time?

A2: Yes. However, the FSA account would become “limited purpose” and can only be used for dental and vision expenses until the HSA account is exhausted. We will be sure that your FSA is set up properly to accommodate this.

Q3: If my spouse and I are both offered a health care FSA and day care FSA plan through our employers, how much can we each elect?

A3: Both you and your spouse can each have health care FSAs at their respective employers up to the max of $2,500. Also, each FSA at each employer is considered family. So it doesn’t matter if the husband’s FSA is paying for wife’s out-of-pocket expenses or visa versa. For day care FSA, the IRS limits the household maximum at $5,000. If you file separate returns as a married couple, it would need to be $2,500 each. Otherwise, just one can select the day care account and elect up to the max of $5,000.

Q4: I had a wellness exam and tests conducted by my Doctor and received my explanation of benefits showing it was applied to my deductible. Is that right?

A4: Maybe, but most oftentimes, no. First, it depends on the type of plan that is offered by your employer. If wellness should be paid at 100%, then what likely happened is the bill wasn’t properly coded when sent to your insurance company. When that happens, call VistaNational’s claim concierge unit! We can call your Doctor, call the insurance company and get it fixed for you! We will let you know when it is fixed and what to expect in the mail.

Q5: I hear a lot of buzz from my employees about healthcare reform. How can I properly educate my employees so they know what the buzz is all about?

A5: We are consistently hosting seminars and webinars for our clients to be sure they are up-to-date on the latest on healthcare reform. Also, part of our service model is to be sure your employees are educated. We can provide materials, have Q&A sessions with your employees and speak to them about the laws and how it may affect them.

Q6: What is considered a qualifying event?

A6: Qualifying events include, but are not limited to, the following:
• Marriage
• Birth, adoption or placement for adoption of a child
• Obtaining legal guardianship of a child
• Loss of eligibility for other health coverage for you or your dependent if:
 a. The other coverage was in effect when you were first eligible to enroll for this coverage;
 b. The other coverage is not terminating for (such as failure to pay premiums or making a fraudulent claim); and
 c. Where required, you stated in writing that coverage under another group health plan or other health insurance coverage was the reason for declining enrollment in this coverage.
• This includes, but is not limited to, loss of coverage due to:
 a. Legal separation, divorce, cessation of dependent status, death of an employee, termination of employment, or reduction in the number of hours of employment;
 b. In the case of HMO coverage, coverage is no longer provided because an individual no longer resides in the service area or the HMO no longer offers coverage in the HMO service area in which the individual resides;
 c. Another group health plan no longer offering any benefits to the class of similarly situated individuals that includes you or your dependent;
 d. When Medicaid or Children’s Health Insurance Program (CHIP) coverage is terminated as a result of loss of eligibility; or
 e. When you or your dependents become eligible for a premium assistance subsidy under Medicaid or CHIP.
• Termination of employer contributions towards your or your dependent’s other coverage.
• Exhaustion of COBRA continuation coverage or state continuation coverage.

Q7: How long do I have to submit an application from the date of the qualifying event?

A7: You have 30 days from the qualifying event date to sign and submit an application.

Q8: I accidently didn’t submit an employee’s application within the required 30 days?

A8: We will submit your application to the insurance carriers for consideration. If approved by the carrier, the retro charges for this enrollment will reflect on your next billing statement.

Q9: I forgot to cancel an employee who left the company and it has been over 90 days?

A9: We will submit your request to terminate your employee to the underwriter for consideration. The carrier has the right to deny the request; however, typically they will process the request if no claims have been processed. If claims have been processed then they will typically terminate the employee the day after the claim was processed.

Q10: When should I terminate my employee; the day they were termed or the end of the month?

A10: This is up to you and how you want to administer it; however, we strongly recommend that you are consistent with how you handle this for all your employees.

Q11: Am I able to term/add an employee and/or dependent, request id cards, change addresses on the carrier’s website?

A11: Yes, If you need help getting access please let one of you Vista Team Members know, so they can assist getting you set-up.

Q12: When is my open enrollment?

A12: Your open enrollment is always 1 month prior to your effective date. For example, if your effective date is 7/1 then your open enrollment would be 6/1 – 6/30.

Q13: I have more than 20 employees, do I have to offer COBRA coverage to all my employees?

A13: YES – Please click on this link for COBRA Q&A.

 

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