Dundee Insurance Agency Ltd.
A Dundee Wealth Management Company

 

Group Benefits Frequently Asked Questions


How can I tell an employee that our plan is mandatory when they have to pay for a portion of the benefits?

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When should I submit a new employee's enrollment forms?
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As an administrator, how should I deal with employees claim problems?
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Can I have our employees contact Dundee Group Benefits directly?
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Can I fax copies of claim or change forms directly to the insurance carrier?
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Is it really necessary to keep copies of all forms and claims?
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How can I tell an employee that our plan is mandatory when they have to pay for a portion of the benefits?

This can be a confusing issue for many plan members and clients. It is a necessary measure in order for the insurance companies to be able to offer a group plan to most small businesses. The reason for this guideline, is to avoid anti-selection, in simple terms, it avoids the situation where most unhealthy employees choose coverage, while the healthy employees would rather not have it. If only the people who needed the benefits were able to enroll, the rates would be completely unaffordable. These guidelines allow the insurance companies to spread the risk and offer coverage to smaller businesses. When new employees join your company it should be conveyed as a condition of employment from the beginning. For further information, please do not hesitate to contact us.

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When should I submit a new employee's enrollment forms?

The choice is up to you, some administrators prefer to hold onto forms until the waiting period is complete, while others prefer to submit the forms immediately after employment. We do however suggest the latter procedure, this way you can be assured that your employee will be enrolled with the plan immediately after the waiting period has been served. Know that should the employee not remain with your company, you are under no obligation to have them remain on the plan. All that is required is a small note indicating the termination date be submitted to your insurance carrier. However, should the enrollment form be submitted 31 days or later from the waiting period, your employee will be viewed as a late applicant and will be required to submit health evidence. The employee also may be subjected to restricted benefits depending on the carrier.

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As an administrator, how should I deal with employees claim problems?

Depending upon your experience with your group plan, you may be comfortable in dealing with the insurance carrier directly. However, should you wish to keep an arms length from these issues or if an issue remains unresolved, we may be able to help. Dundee Group Benefits will strive to address any unresolved issues or concerns that you or your employees may have. Please do not hesitate to contact us. We will do all that we can to help and would be more than happy to contact the insurance carrier on your behalf.

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Can I have our employees contact Dundee Group Benefits directly?

With our vast collective experience, we will be more than happy to deal with your employees on a direct basis, if you so wish. For further details, please contact us.

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Can I fax copies of claim or change forms directly to the insurance carrier?

No, although many insurance carriers are coming up with more and more technologically advanced websites, originally signed documentation are still normally required for all claims and changes. As a preventative measure you may wish to fax a form initially, but due to insurance guidelines, most carriers require originally signed documents. You will have to forward the originally signed copy to your carrier in order to make any changes.

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Is it really necessary to keep copies of all forms and claims?

It would be best to advise all plan members of the importance of keeping a copy of all receipts and forms submitted. This may avoid potential delays should the paperwork not be received by your carrier. Simply advise employees to make this a habit and then once the claim has been paid or the change processed, they can then choose to discard of these copies.

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