Eligibility
To participate in any of these supplemental indemnity plans an employee must be
actively employed. The supplemental insurance is offered on a guaranteed issue
basis and covers all pre-existing conditions provided the employees enroll when
first eligible or during open enrollment. Eligibility into an individual’s
health plan depends on the employee’s residency. In New Jersey and New York
individual coverage is offered on a guaranteed issue basis, however pre-existing
conditions may not be covered if you have not maintained prior coverage.
Eligibility for the NJ or NY individual health plans also requires employees to
pay 100% of the costs for their health insurance. All other states require you
to submit medical evidence to obtain an individual health plan in that state
unless you can qualify for a federal or state subsidized program. Please call us
and we can help you navigate your options.
Pre-existing Conditions on Horizon Health Plan
NJ 2010 Buyers Guide
Pre-existing conditions may apply when a new enrollee has not had previous
coverage within the last 30 days from the date the new individual health plan
will be placed in force. We have attached the most recent copy of the NJ State
Buyers Guide using the link above detailing eligibility and pre-existing
condition requirements. As a general rule, anyone that has maintained prior
coverage is given credit towards the length of time they had previous coverage.
New Jersey and New York are guaranteed issue states for individual coverage so
you cannot be turned down no matter what health conditions exist, however if you
are subject to a pre-existing condition limitation, only the supplemental plan
benefits may cover those types of expenses during the first year of coverage
depending on your unique situation.
Supplemental Plans waive all pre-existing condition limitations and are
guaranteed issue if you enroll during open enrollment. Limited supplemental
medical plans can be written on a standalone basis and can fill gaps in any
health plan. If you live outside of New Jersey, we can work with you to purchase
a plan in your resident state, thus generating the same savings potential. Call
Toll Free 1-800-662-3982 for help.
Coverage Effective Date
Coverage will start on the first of the month following completion of the
required forms and first month’s premium payment. Any individual health plan can
be directly billed or processed using Automatic Check Collection (ACH). However,
the supplemental plan requires (ACH) and a $2.00 monthly charge for processing
unless payroll deducted. Please be sure to add the processing fee to the ACH
enrollment form when indicating the premiums that should be deducted each month
on your selected supplemental plan. Payments will be taken in two deductions,
first from “Horizon BCBS” ACH plan and second for the supplemental from
“Select Benefit Administrators”.
Your employer will not bill or be
responsible for any servicing of this program. Please use the toll free service
numbers listed on your enrollment cards for any questions regarding claims or
billing.
How to Enroll Online
Click Here
to
enroll online with the NJ Horizon
EPO Basic
Plan. The
basic plan was designed to work with supplemental plan 1 to offer you 100%
benefits for the most used services however other plan may be more suitable
depending on the amount of out of hospital expenses and the need for brand name
prescription coverage or chemotherapy. You can mix and match any major benefits
plan with either supplemental plan. We will be notified electronically of your
enrollment status.
To enroll any
supplemental plan
And for ACH
(Direct bill of
supplemental plan requires ACH plus a $2.00 monthly service charge) Mail the
original form, a check for the 1st months premium payable to Select
Benefit Administrators and a voided check to the following address.)
Print and mail the forms as well so we have original signatures. Mail to 1 Stop
Benefits, Inc. 1546 Old Farm Court Yardley PA 19067
Details as to
the supplemental benefits program are available in PDF format.
Click Here
How to Enroll Using Paper Forms
Online enrollment is both secure and more efficient however, in order to enroll
employees must complete all required forms and mail them to us for processing.
Please include your email address and daytime phone number. Benefits only start
the first of the month following receipt of the insurance company of all
required forms and first month’s payment. Please do not cancel any previous
coverage until we verify your new plan is in force.
(Direct bill of supplemental plan requires ACH plus a $2.00 monthly service
charge) Mail the original form, a check for the 1st month’s premium
payable to Select Benefit Administrators and a voided check to the following
address.)
Payment for any individual major
medical plan should be made payable to the insurance company.
Mail all forms to 1 Stop Benefits, Inc. 1546 Old Farm Court Yardley PA 19067.
Call 1-800-662-3982 if you have any questions. Email Us at
Service@1StopBenefits.com
How to Enroll For New York or Pennsylvania
Online enrollment is both secure and more efficient however, you
can complete the PDF forms below the online enrollment links. Note Empire BCBS
will not let us support their individual plans so please mail your applications
directly to them. If enrolling with any carrier with paper forms and not
electing ACH payments, please submit a check for the first month’s premium
payable to the carrier.
Mail all forms to 1 Stop Benefits, Inc. 1546 Old Farm Court Yardley PA 19067.
Enrolling In Plan 3 should be done as instructed above.
AETNA ONLINE ENROLLMENT
EMPIRE
BCBS NY ONLINE ENROLLMENT
PA PDF Aetna Enrollment
PDF
Empire Hospital Enrollment
Changes in Coverage
Most individual health plans can be altered once a year however, any plan that
requires medical evidence can only downgrade coverage on their anniversary date
without obtaining prior approval from the insurance company. The NJ Individual
market allows changes in plan design once a year in November for a January 1
effective date. Your individual health plan is guaranteed renewable for life
and you can cancel your individual coverage in any given month. The supplemental
plan can be maintained whether you enroll in any other health plan or maintain
no other insurance. Changes in enrollment for direct bill customers can take
place the first of the month any time of the year. All change requests must be
done in writing and received no later than 3 days prior to stated change. You
can fax any change request to 1-888-662-3920. Note that if you are adding a
newborn you must send in this request within 31 days of birth or no coverage
will be given for the child upon birth. A change form can be downloaded by
Clicking Here.
Continuation
The individual health plan can be continued indefinitely. The supplemental plan
coverage is based on you being an active employee. However, if a death occurs
premiums will be waived for two years on any covered dependent on the plan. All
others can elect to continue the coverage for a minimum of 18 months from the
date employment ends. The lengths of continuation model those of COBRA.
Continuation can also occur if you become eligible under another union or
employer offering this coverage. Let us know if you want your new employer to
consider this plan.
Claims Questions
Once you are enrolled, you will receive both an identification card and plan
description as well as claim forms. If you have any questions regarding claims,
please call Select Benefit Administrators on your identification card. If you
need a claim form, you can download it here.
Claim Form