OPEN ENROLLMENT & VERIFICATION 2021
Memorandum – Mailed on February 17, 2021:
The Benefits Office is conducting simultaneously for the Welfare Plan two related processes. NECA Local No. 145 IBEW Welfare Plan is required by a provision under the Affordable Care Act (ACA) to offer open enrollment for the plan year 2021. Please read this memorandum carefully since it affects your coverage by the Welfare Plan. Please note that some of you are not participants in the HRA or dental plan so those two items will not apply to you.
The Plan must verify everyone covered is an eligible participant and/or dependent. The Plan’s duty is to verify that no fraud is being conducted. Below are some examples as to how fraud could happen.
- Participant was married and goes through a divorce. The participant fails to inform the Benefits Office of this change in “family status”. The spouse continues to have claims paid on her behalf.
- Participant is married and spouse and/or dependent child has coverage through his/her employer. The Benefits Office is not notified the spouse and/or dependent child has other coverage. Claims for the spouse and/or dependent child have been paid through this Plan as primary and should have been paid as secondary.
- Participant is married and has two dependent children covered on this Plan. The participant’s spouse has family coverage through his/her employer. Both the participant and the spouse cover both children and the spouse’s birthday is earlier in the calendar year. The Benefits Office was not aware the spouse had coverage for the children and this Plan has been paying as primary. The spouse’s plan should be paying primary.
The Plan must be sure all updated information is received. The purpose of doing a verification is to confirm the Benefits Office has the correct information for you and your dependents (if applicable). There are three items that each require your attention:
- Verification Form – This form is intended for “Verification of Member Data” and “Open Enrollment Period”. Please read the information below thoroughly.
- Verification of Member Data – This year there are two ways of submitting the verification form to the Benefits Office. You may file it electronically or via paper form, you may use whichever way works best for you. If you choose to file it electronically, which only will be available until March 17, 2021, you will need to go to the benefits website (see enclosed instructions) and log into the MEMBER DASHBOARD and click on the link Open Enrollment 2021. This will allow you to review the information the Benefits Office has on record for you and your covered dependents. Please review this information carefully. If you need to make a change, the only changes you can make on-line will be your home address, phone number and e-mail address. Those items will be outlined in gold. At the bottom of the electronic form you will be given an opportunity to sign electronically regardless if you are making any changes. Once you have signed the form click the “Submit” link, then the Benefits Office will be notified you have completed the form.
If you prefer, you may complete a paper form or if you need to make any other changes (such as a change in your marital status or removing a dependent, etc.) you must contact the Benefits Office and a paper form will be mailed directly to you. You will be able to make those changes directly on the form, please be sure to write in a readable manner. Return the signed and dated form plus any additional paperwork to the Benefits Office no later than March 17, 2021.
If the Benefits Office does not receive the form by March 31, 2021 all medical, dental, vision and prescription claims will be DENIED for you and your dependents (if applicable). Once the Benefits Office receives the form it will be verified to be completed properly. If there were any claims denied after March 31, 2021, you will be responsible for reaching out to those providers and advise them to resubmit those claims for processing.
- Open Enrollment Period – The Plan is having an open enrollment period from February 17, 2021 through March 17, 2021, in order to provide you the opportunity to enroll any eligible spouses or dependents who are not currently covered, but do meet the Plan’s eligibility requirements. You will need to call the Benefits Office and we will send you a packet which will include the Verification Form for your use in providing the information required to add the eligible person to the Plan. A Summary of Benefits and Coverage will be enclosed for your information. The Plan reserves the right to request verification of eligibility (e.g., marriage license, birth certificate, etc.). In order to enroll any eligible spouse or dependent you must sign and date the form, and return it to the Benefits Office NO LATER THAN FRIDAY, MARCH 17, 2021. If this form is not returned by the due date you will NOT be able to enroll a spouse and/or any dependents during the 2021 open enrollment period.
If you do not enroll any eligible spouse/dependent(s) during this open enrollment period, they cannot be enrolled until next year’s Open Enrollment Period, or you experience an event that results in the opportunity for a Special Enrollment. These events are:
- Loss of other coverage due to termination of employment, reduction in work hours, death, divorce, or legal separation (proof of loss of other coverage must be submitted).
- Gaining a dependent through marriage, birth, adoption, or placement for adoption (proof must be submitted).
In order to enroll after one of these events, the Benefits Office must be notified within 31 days after the event.