FAQs

Answers to Frequently Asked Questions (FAQs)

At VistaNational, we receive questions every day and have compiled a list of the most frequently asked questions with helpful answers.  If you have a question that isn’t addressed, don’t hesitate to contact us for a quick and accurate answer from one of our professionals.

Employee Questions

What is considered a “qualifying event”?

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:
    • The other coverage was in effect when you were first eligible to enroll for this coverage
    • The other coverage is not terminating for (such as failure to pay premiums or making a fraudulent claim)
    • 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:
    • Legal separation, divorce, cessation of dependent status, death of an employee, termination of employment, or reduction in the number of hours of employment
    • 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
    • Another group health plan is no longer offering any benefits to the class of similarly situated individuals that includes you or your dependents
    • When Medicaid or children’s health insurance program (CHIP) coverage is terminated as a result of loss of eligibility
    • When you or your dependents become eligible for a premium assistance subsidy under Medicaid or CHIP
    • Termination of employer contributions towards your or your dependents’ other coverage
    • Exhaustion of COBRA continuation coverage or state continuation coverage

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

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

Maybe, but most often the answer is 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 Vista’s claim concierge unit. We can call your doctor and the insurance company to get it fixed for you! We will let you know when it is fixed and what to expect in the mail.

Both you and your spouse can each have healthcare FSAs at your respective employers up to the maximum 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 the wife’s out-of-pocket expenses or visa versa. For a daycare 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 daycare account and elect up to the max of $5,000.

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. For example, if your birthday is July 5th and your spouse’s birthday is March 15th, your spouse’s plan would be primary for the children.

HR Professional Questions

When is my company’s open enrollment date?

Your open enrollment is always one (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.

Yes. If you need help getting access, please let one of your Vista team members know so they can assist you in getting set-up.

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.

Vista 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, they will typically terminate the employee the day after the claim was processed.

Vista 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.