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| Billing | |||
| Policy Administration | |||
| Eligibility | |||
| ID Cards | |||
| Dental | |||
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Questions & Answers
Membership
Q: What is the history of the program?
A: ISEBA, a 28E entity, replaced the Iowa Association of School Boards (IASB) Health Insurance Trust effective July 1, 1999. It is just the beginning of what will become the model for delivering customized, high quality and affordable school employee benefits.
Q: Who is the Employee Benefits Advisory Council?
A: During the past year, IASB, Iowa State Education Association (ISEA) and the Employee Benefits Advisory Council, (comprised of human resource personnel, superintendents, teachers, ISEA representatives, Area Education Agencies(AEA) representatives and Iowa Association of School Business Officials(IASBO) representatives), have worked to create and deliver a premier and customized school employee benefits program with affordable, quality products and services and high levels of user education to assist in claim reduction. Both IASB and ISEA support the Employee Benefits Advisory Council.
Q: How do I become an ISEBA Member?
A: A school can become an ISEBA Member by having its board adopt a resolution and then complete, sign and file the ISEBA documents. There is no waiting period to rejoin ISEBA should a school not participate in a given year.
Q: What is the connection between IASB and ISEA?
A: Both IASB and ISEA endorse ISEBA. IASB and ISEA have a partnership to jointly govern ISEBA as of July 1, 2000 to provide affordable, customized school employee benefit products and services and high levels of user education to assist in claim management.
Billing
Q: When is my payment due?
A: Payment is due by the first of the coverage month (i.e. January 1 for January’s coverage month). Most invoices aren't mailed until the second or third week of the month prior to the coverage month. We encourage you to remit payment as close to the due date as possible so that both billings and claims payments can remain current.
Q: Is it required that I adjust my monthly premium payment to reflect the changes I am submitting?
A: No. You can submit changes without adjusting the premium amount due. Your next invoice will indicate the credit or the back charges for the changes submitted.
Q: How frequently should I review the invoice?
A: ISEBA strongly encourages all employers to review their invoice on a monthly basis and to report all changes, errors, and corrections to ISEBA timely to avoid any claims or premium liability.
Q: Where do I send my premium payment and whom should I make checks payable to?
A: All checks should be made payable to ISEBA and sent to ISEBA’s lockbox at PO Box 755 Des Moines IA 50303-0755. Please do not send enrollment changes with your premium payment.
Q: I have a new hire that needs to be added to the plan. Do I send the enrollment application with my premium?
A: No. All enrollments, terminations and changes should be sent directly to ISEBA at 4445 Corporate Drive Suite 124 West Des Moines, IA 50266 via mail, fax or e-mail within 60 days of eligibility. Please ensure that the enrollment application is complete and that the correct group number and effective date are written clearly on the application. List all information on the Group Insurance Change Form (GICR).
Q: When can I expect to see changes submitted reflected on the invoice?
A: Changes submitted before the 10th of the month will appear on the next month’s invoice. For example, changes submitted by August 10th will appear on the September invoice; changes submitted after the 10th will appear on the October invoice.
Q: Is there a waiting period that must be satisfied before new employees can be added to the group plan?
A: ISEBA does not impose a waiting period however the effective date of coverage should coincide with the member and dependent eligibility provisions stated in your benefit booklet.
Q: Do members turning age 65 automatically drop off the plan?
A: If the member is coded as an Early Retiree, then ISEBA will notify the employer that coverage will terminate the end of the month prior to the member’s 65th birthday. The notice will also include information on the Retiree options offered through ISEBA. If the member is not coded as an Early Retiree then the member will remain active on the invoice until we receive a termination notice from the employer.
Q: Do I have to report a member or dependent’s termination of coverage if I have given them a COBRA notice?
A: Yes, all terminations should be reported to ISEBA to avoid premium and claims liability. If the qualified beneficiary elects COBRA then we will reinstate their coverage.
Q: When do full-time students qualify for the 90 days of continuous coverage?
A: Coverage may be continued, subject to payment of any required contribution, for any Dependent age 19 and over who ceases to attend school on a full-time basis, until the date 90 days after the end of the calendar month in which the Dependent ceases to attend school on a full-time basis.
Policy Administration
Q: Am I responsible for sending out Certificates of Creditable coverage in order to comply with the guideline of the Health Insurance Portability and Accountability Act (HIPAA)?
A: No, Wellmark will issue Certificates of Creditable coverage and send them to the employer when a member's coverage is terminated. It is the employer’s responsibility to forward the certificates to terminated members.
Q: Can an employee who declined a particular part of the benefit package at the time of hire elect to add the coverage at a later date?
A: All elections made during the initial enrollment period must remain in effect until the next annual open enrollment period unless a qualifying event occurs.
Q: What is a qualifying event?
A: An occurrence entitling a person to change existing coverage or elect continuation outside of open enrollment. For example:
- Marriage or divorce
- Death or termination of coverage of a dependent
- Birth or adoption of a dependent
- Spouse begins or ends employment
- Employee or spouse changes from part-time to full-time employment or vice versa
- Employee or spouse takes an unpaid leave of absence
- Significant change in health coverage of the employee or spouse through spouse's employer plan
Eligibility
Q: Who is considered a full-time student?
A: A student enrolled at an accredited institution of higher learning such as a college, university, or trade school. The number of hours required per semester for full-time students is based on the school's definition, although this is generally 12 hours or more.
Q: How many hours must an employee work to be eligible for enrollment?
A: Employees must be working a minimum of 30 hours and be considered full-time employees by the school to be eligible for enrollment. Please refer to the Eligibility Rules Web page for a detailed description of eligible employees.
Q: Do all of my employees have to enroll in the health insurance plan?
A: If the plan is non-contributory 100% participation is required. If the employees contribute to their benefits ISEBA requires at least 75% of the group including valid waivers. In no case will ISEBA allow less than 50% participation.
Q: Do any of the medical plans impose a limit for pre-existing conditions?
A: Yes. Pre-existing conditions apply to late enrollees only.
ID Cards
Q: When will members receive their ID cards?
A: ID cards will be sent to the school within 10-15 business days from the time the coverage is added into the carrier's system.
Q: I have not received my medical cards and I need to see a doctor. Will my services be covered?
A: Yes, coverage for eligible services will be provided under the provisions of the benefit plan. However the member will be responsible for paying for the service and then filing a claim for reimbursement.
Q: What happens if an employee needs a prescription and they have not received their ID cards?
A: The employee will be responsible for paying for the prescription and filing a prescription drug reimbursement claim form once their enrollment application has been processed.
Dental
Q: Is there a list of participating dentists that my employees must use for Dental?
A: In order to obtain benefits at the highest level, we encourage employees to use dentists that accept Delta Dental. Employees can call Delta Dental at 800-544-0718 to obtain a listing of participating dentists or visit their website at www.deltadentalia.com.
Q: What happens if I am travelling and need dental care away from home?
A: The Delta Dental identification card is recognized and accepted in all 50 states. Members simply need to present their ID card and the Delta Dental provider will process all paperwork.
Last updated: Thursday, August 19, 2004 Page:
This information is not intended for use without professional advice. While we have attempted to make this site as accurate as possible, it is only a summary. For more information, see our disclaimer.