3.520 RCUH Health Plans

Policy 3.520 HEALTH PLANS (Medical & Dental)

Date Composed: 08/07/1997

Date Modified: 07/01/2010, 07/01/2011, 01/01/2012

Revised: 07/30/2003, 07/01/2006, 07/02/2007, 07/01/2009, 07/01/2011, 01/13/2012, 3/12/2012

Policy:

It is the policy of the RCUH to provide health insurance benefits to eligible employees and with the necessary information to enroll.

Applies to:

This policy applies to Regular status employees who are 50% FTE or more.

Details of Policy:

1) Health Plan Options - The RCUH offers six (6) medical plan options (includes medical, prescription drug and vision coverage) and one (1) dental plan for the employee and eligible dependents.

a) Kaiser Permanente Hawaii Medical Plans B & A: See Kaiser/RCUH website for additional information. The covered individual(s) must be residing in Hawaii in order to enroll into a Kaiser Plan.

b) HMSA Medical Plans: Health Plan Hawaii-Basic, Health Plan Hawaii Plus, Preferred Provider, and Comprehensive Medical. See HMSA website for general information about these plans. The covered individual(s) must be residing in Hawaii in order to enroll into the HMSA Health Plan Hawaii-Basic and Health Plan Hawaii Plus plans. The Preferred Provider and the Comprehensive Medical plans are the only medical plans that non-Hawaii residents may enroll into. To browse for participating providers or facilities, please click on the “Find a Doctor” or “Find a Facility” links.

c) Hawaii Dental Service (HDS) Dental Plan: See HDS website on HDS for general information about this plan and the provider list.

2) Summary of Benefits and Cost of Plans: Provides a summary of insurance coverage and the cost of monthly premiums

a) Kaiser Plans A&B Summary

b) HMSA Medical Plans Summary

c) HDS Dental Plan Summary

3) Dependent Coverage:

a) Dependents eligible for enrollment include:

Legally married spouse (consistent with the definition of marriage as defined under the laws of the State of Hawaii);
Civil Union Partner (consistent with the definitions of civil union partnership as defined under the laws of the State of Hawaii)
Same or opposite-sex Domestic Partner. Click here for more information on Domestic Partner enrollment requirements. This addendum will provide an overview of the provisions of this arrangement.
Disabled children over age 26 who cannot support themselves because of a mental or physical disability which occurred before the child's 26th birthday;
Children under age 26

b) Required Documentation for Dependent Coverage:

i. It is the responsibility of each employee to provide updated and accurate information on the group enrollment form. Proof of relationship (i.e. marriage certificate, civil union certificate, birth certificate, etc.) must also be submitted to RCUH Human Resources at the time of enrollment. Failure to provide the required proof of dependent status by the established deadlines may result in no coverage of dependents, repayment of ineligible premiums paid by RCUH, and possibly other personnel actions.

ii. Employees are also required to inform the RCUH of changes to dependent’s eligibility status (i.e. in the case of a divorce, the spouse is no longer an eligible dependent).

4) Effective Date of Coverage:

a) The effective date of coverage is dependent on the date of hire or date of FTE change. Health premium deductions are made in the pay period prior to the coverage date (Example: Monthly premium deduction for coverage period February 1-28 is pre-deducted in pay period ending January 31).

b) Employees hired and/or whose FTE changes between the 1st to the 20th of the month will be eligible the first day of the following month (Example: Hired and/or FTE change February 1, insurance is effective March 1).

c) Employees hired and/or whose FTE changes between the 21st to the end of the month will be eligible the first day of the second month (Example: Hired and/or FTE change February 21, insurance is effective April 1). However, if employees request coverage from the first day of the following month (i.e., March 1), employee will be responsible for the entire (employee and employer share) cost. A personal check would be required no later than one week prior to the date of coverage.

5) Cost of Health Plans:

a) The RCUH and employee share the cost of the health plans. This cost sharing is reviewed annually and may vary from provider plan to provider plan (60% of the "best rate" is paid by RCUH and the remaining 40% + the difference between the selected plan rate and the best rate is paid by the employee).

b) The employer's share of the health premiums are charged to the project from which the employee's salary is paid. The employee's share of the health premiums are deducted through payroll deductions every pay period, approximately 1 month in advance.

6) Falsification of Documentation:

Failure to notify RCUH of dependent's eligibility status, providing inaccurate information or falsifying the information contained in the Benefits Group Enrollment form may result in disciplinary action including termination of employment.

Legal action may be brought against the Employee and/or Dependent/Domestic or Civil Union Partner for any losses, damages (including, but not limited to reasonable attorneys’ fees and other legal expenses), financial or otherwise, due to false statements provided on enrollment/related forms or for failure to timely notify RCUH of changed circumstances as required. In addition, any health benefits (ex., monthly premiums, claims, etc.) paid by the RCUH health plans on behalf of the Employee’s dependents will be reversed and become the responsibility of the Employee.

7) Open Enrollment:

Annually, the RCUH schedules an open enrollment period to permit changes in plan selection or to permit enrollment by those employees who had not done so during their initial eligibility period. The open enrollment period is normally in April/May with plan selections and changes effective July 1.

8) Managing Your Health Plans:

The RCUH Human Resources Department conducts periodic plan reviews. These reviews dictate plan modifications, introduction of new providers, changes to the provider pool, etc. Each year, the RCUH Human Resources Department will conduct plan negotiations with the objective of achieving the most cost effective benefit plan. Upon completion of these negotiations, rate schedules are developed in accordance with the most competitive rate/cost sharing structure. The Director of Human Resources is responsible for all plan design, restructuring, and negotiations.

Procedures:

1) For Initial Enrollment at Time of Hire:

a) New hires will be required to access the Electronic Hiring System to enroll into RCUH’s group health insurance plans.

b) If eligible dependent(s) will be added to the plan, documentation to confirm the dependent status will be required upon initial enrollment (i.e. official marriage certificate, civil union certificate, birth certificate, adoption documents, etc.), and will be due no later than two (2) months from the date of hire. Failure to provide the required documentation may result in cancellation of coverage for the dependent(s).

c) Eligible employees who elect to decline health benefits must indicate, "I do NOT wish to enroll at this time".

d) Upon completion of the new hire documents on the Electronic Hiring System or receipt of RCUH Group Benefits Enrollment/Change Application Form (Form B-5) by the RCUH Human Resources Department, the employee will not be permitted to change his/her original enrollment election until the annual benefits open enrollment period, with the exception of allowable changes related to a qualifying event.

e) When selecting the HMSA Health Plan Hawaii Plus or Basic plans, the new hire must select an HPH Health Center (HC) and a Primary/Personal Care Physician (PCP) for all individuals enrolled onto the plan. If a HC and/or PCP is not selected, HMSA will automatically assign the HC and/or PCP. Changes to the HC and/or PCP may be made at any time by notifying HMSA. The effective date of the change in HC and/or PCP will be subject to HMSA’s established policies. Go to the www.HMSA.COM website to view the selection of HPH Health Centers and Primary Care Physicians.

2) Voluntary Cancellation of Health Benefits:

a) Health benefits may be canceled by submitting to RCUH Human Resources, a written notification or by completing the RCUH Group Benefits Enrollment/Change Application Form (Form B-5). Notification must be received by RCUH Human Resources by five business days prior to the effective date of cancellation (Example: Form must be received by January 25 for cancellation to be effective February 1).

b) Subsequent re-enrollment may be made only during the open enrollment period.

c) Health benefits are automatically canceled after the 1st day of the month following termination of employment or change in FTE status below 50%.

3) Cancellation of Benefits Due to Authorized Leave Without Pay (LWOP):

a) When an employee is granted an authorized Leave of Absence Without Pay (LWOP) and the LWOP is not due to Family Leave or a work-related injury/illness (i.e. workers compensation), the employee's participation in health benefits will be cancelled if the employee's payroll cannot cover the employee's portion of the monthly health premium.

b) If the LWOP is due to Family Leave or a work-related injury/illness resulting in total disability, participation in health benefits may continue, provided the employee pre-pays his/her share of the monthly premium.

c) A personal check made payable to the "RCUH" is due 5 days prior to the month of coverage. Payment is due directly to the RCUH Human Resources Department.

d) The RCUH will cancel the health plan enrollment when an employee does not pay the monthly premiums on a timely basis. Employees should receive a Consolidated Omnibus Budget Reconciliation Act (COBRA) Notice/Election form which will allow them to continue their health plan(s) on an individual basis for a maximum specified period of time. Upon the employee’s return to work, the employee will be able to re-enroll their group health plans by submitting the RCUH Group Benefits Enrollment/Change Application Form (Form B-5) within 30 days of their return.

4) Enrollment or Adding Dependents Due To Qualifying Event:

a) Employees may either enroll into health insurance or add eligible dependents onto existing health insurance mid-year due to qualifying events.

b) Qualifying Events include:

i. Birth or adoption of a child (add child),

ii. Marriage (add spouse),

iii. Loss of insurance coverage (add employee, spouse and/or child),

iv. Meeting the eligibility requirements for Domestic Partner status,

v. Meeting the eligibility requirements for Civil Union Partner status.

RCUH Group Benefits Enrollment/Change Application Form (Form B-5) must be submitted with the proof of qualifying event within 30-days from the date of the qualifying event. Enrollment will be effective the 1st day of the month following submission and approval of the enrollment documents (Example: If you were married on April 28, and your enrollment documents are submitted to RCUH on May 3, enrollment for your spouse will be effective June 1). An exception to the enrollment date is made for the birth of a child. Enrollment for birth of a child is retroactive to the date of birth, provided the employee submits the required documents within 30 days from the date of birth.

c) If an employee fails to provide RCUH with the required documents within the 30-day window, the enrollment is denied and the employee may submit enrollment during the upcoming annual Open Enrollment Period.

d) Examples of acceptable documentation for qualifying events are the following:

Birth of a Child: Certificate from a health care provider or department of health.
Adoption: Certification issued by a recognized adoption agency, the attorney handling the adoption, or by the individual officially designated by the birth parent to select and approve the adoptive family showing placement of the child with the employee.
Loss of insurance coverage: Letter from health insurance provider, employer confirming date of benefit cancellation or divorce decree.
Meeting the eligibility requirements of Domestic Partnership: Declaration of Domestic Partnership and Affidavit of Dependency or Tax Purposes. See addendum on Domestic Partnership.
Meeting the eligibility requirements of Civil Union Partnership: Certification issued providing proof of the civil union solemnization. Note: If previously registered in a reciprocal beneficiary relationship, proof of termination must be provided to the civil union agent prior to the issuance of a civil union license if the termination occurred within 30 days of applying for the civil union license. See the Hawaii State Department of Health website for more information on obtaining civil union certification in Hawaii. Civil unions/same-sex marriages performed in other states would be recognized as civil unions in Hawaii.