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Answers to Q4 Frequently Asked Questions

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Throughout the year, especially during Q4, we know you are bound to have questions about Underwriting, Client Experience, Enrollment, and Compliance. That’s why we’ve compiled this list of the most frequently asked questions (FAQs) during peak season.
 
We have organized them below, based on subject matter.
 
If you have a question not addressed below, contact your Word & Brown representative.
 
Underwriting
 
When will I receive approval for my client, XYZ group?
Case approval depends on the carrier; see the charts below with state-specific information.
 
California Carrier Carrier Review and Approval
Provided in Approximately
ID Numbers
Provided in Approximately
Aetna 2 to 3 Days 3-5 Days
Anthem Blue Cross 1 to 2 Days 1 to 2 Days
Blue Shield of California 1 Day 1 Day
CaliforniaChoice 3 Days Does not provide ID numbers; supplied by most participating carriers.
Cigna + Oscar 2 to 3 Days 2 to 3 Days
Kaiser Permanente 2 Days Does not provide ID Numbers
Health Net 3 Days 3 to 4 Days
UnitedHealthcare 1 to 2 Days Does not provide ID numbers
Note: Estimated timeline is subject to change based on peak season volume.
 
Nevada Carrier Carrier Review and Approval
Provided in Approximately
ID Numbers
Provided in Approximately
Anthem Blue Cross Blue Shield 2 to 3 Days 1 to 2 Days
Prominence 7 to 10 Days 1 Day
Note: Estimated timeline is subject to change based on peak season volume.
 
When can we expect Member IDs and/or ID Cards for enrolled employees and dependents?
The estimated delivery for physical ID cards is 7 to 10 days. Member ID information is typically available online at the carrier’s portal – approximately 1 to 3 days from the case approval date.
 
Client Experience
 
How do I update Ease with renewal plan information?
Plans do not automatically renew in Ease. New plans, rates, and benefits will need to be updated. 
 
The W&B Client Experience team can assist with updating renewal plans in Ease. An intake form is required as well as the renewal quote (see page 1 of intake form for full details). The most recent intake form can be found on the W&B website. Please reach out to your W&B Sales team to discuss access to our Client Experience team. Access is based on your W&B production.
 
How do changes get sent to the carrier once renewal is complete in Ease?
If your group is changing carriers at renewal, please work with your W&B sales team on pulling the forms and submitting them to W&B Underwriting.
 
For groups renewing with the same carrier, forms will need to be reviewed and pulled from Ease and submitted to W&B Client Experience (for our account managers’ review and submission to the carrier), you can send directly to the carrier.
 
For carriers with connections in Ease, review the “Ready to Submit” information in the Ease system. See Ease site for full details for post-open enrollments. Please reach out to your W&B Sales team to discuss access to our Client Experience team. Access is based on your W&B production tier.
 
Why is my request taking longer than I expected?
Average carrier turnaround times are usually extended during Q4, but we will work to get your request to the carrier in the quickest way possible using a portal or API when available.
 
If you have an urgent access to care need, please indicate in the ticket request and work with the account manager and your Sales team to escalate with the carrier.
 
If a member needs to access care prior to having an insurance ID card, we will work with you to help submit claim for reimbursement as needed.
 
Enrollment
 
Can you send me Enrollment Kits?
You can download copies on your own from the Word & Brown website.
 
What do I need to do to ensure my clients have access to the providers they want in the plans they are considering?
Visit our website for instruction on using our Provider & Rx Resources. You can also complete a Provider Search Request and send it to your W&B representative; our team of specialists will then do the provider search work for you.
 
Compliance
 
What is the ACA Affordability percentage for 2024?
The IRS announced the “affordability” threshold for 2024 ACA plans is 8.39%, down considerably from 9.12% for plan years beginning in 2023.
 
Does the ACA employer mandate apply to any of my groups?
It could. The Affordable Care Act employer mandate applies to Applicable Large Employers (ALEs). According to the IRS, an employer that had at least 50 full-time employees, including full-time equivalent (FTE) employees, on average last year are most likely an ALE for the current year.
 
Employers determine their ALE status annually on or around January 1st, by evaluating the average size of its workforce during the preceding calendar year. It’s possible for an employer to be an ALE one year, and not in the next (or preceding) calendar year.
 
For each month of the preceding calendar year, the employer calculates: (Number of Full Time [FT] employees) + (Number of Full Time Equivalent [FTE] employees). Then, the employer calculates an average of all 12 months’ results: (Sum of each month’s results) ÷ 12. If the employer has a result of 50+, then the employer is an ALE for the entire new calendar year. This means, the ALE must comply with the ACA’s employer mandate in the new year and must later report its offers of employee coverage to the IRS at the beginning of the next calendar year. The employer remains in the ALE (or non-ALE) category for the entire year, regardless of group size fluctuations throughout the calendar year.
 
Visit the IRS web page for additional information about determining an employer’s ALE status. The W&B ACA Quick Reference Guide discusses ALEs in more detail.
 
How do my clients determine whether their businesses are an Applicable Large Employer (ALE) as it relates to the ACA employer mandate?
Your client can determine its ALE status by reviewing the average size of its workforce during the preceding calendar year. A Group Size Calculator and a Full-Time Equivalent Calculator are among several calculators offered on the W&B website. Refer to the ACA Quick Reference Guide for additional information. (See pages 3-9.)
 
What do employers need to report?
The ACA requires that Applicable Large Employers (ALEs) report annually on their offer (or non-offer) of “affordable” health insurance coverage to full-time employees and their eligible dependents after the conclusion of their ALE year. That includes Minimum Value (Bronze tier or better) Minimum Essential Coverage (MEC), and the cost and affordability safe harbor(s) for such coverage. If an employer does not offer affordable MEC coverage, the employer may be subject to ACA penalties. (More details are outlined on page 10 of the ACA Quick Reference Guide.)
 
What sort of turnaround can I (or my agency) expect from the Compliance team?
Compliance response times vary by topic and are influenced by your broker or agency tier. They will generally not exceed three days, regardless of tier, during most times of the year. If you’re uncertain of your tier, talk with your W&B rep. (Tiers are based on your total book of business written through Word & Brown.)
 
Can our agency request training for our affiliated brokers?
WBCompliance does offer the option for customized training for qualified agencies. Your broker tier affects your eligibility; ask your W&B rep for more information.
 
What the best way to contact Compliance?
The best option is usually email. (The department staff recommends email correspondence, so we have a paper trail for each inquiry.)
 
Phone calls are your second-best option.
 
Use the information below.  
Watch our Newsroom for additional articles on how to keep your business flowing during Q4 – and all year long.
 

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