Does an employer have to offer a HealthPartners medical plan in order to offer HealthPartners dental plans?
HealthPartners medical and dental plans are available separately.
What is the size breakdown for large and small employers?
Small Employers: 2 to 50 employees who work more than 20 hours per week.
Large Employers: 51 or more employees who work more than 20 hours per week.
Do plans have participation requirements?
Small Employers: Medical plan participation requires 75 percent of eligible employees, or a minimum of two employees minus any eligible individual or dependent waivers. For dental, the requirements are 75 percent of all eligible employees, with a minimum of two employees. Voluntary dental plans require five or more enrolled employees.
Large Employers: Medical plan participation requires 80 percent of eligible employees without other group coverage, and a minimum of 50 percent of the entire population. Contributory dental plans require 75 percent of all eligible employees after waivers and 50 percent of the entire employee population. Voluntary dental plans require 50 percent of eligible employees if under a Section 125 plan or 75 percent of all eligible employees with a payroll deduction plan.
How does pooling affect group rates?
For small groups, pooling helps eliminate significant premium fluctuations. The medical claims experience for the entire pool is reviewed and adjusted based on claims expectations for the new period.
For large groups, the groups medical claims experience, census, plan design and other variables are used in calculating rates. Pooling is typically used only for catastrophic claims.
Are there waiting periods for new groups or new employees?
HealthPartners does not have any waiting periods for medical or dental coverage.
Employers, however, may set their own waiting periods for employee coverage. Some employers also exclude pre-existing conditions from their policies. This means that members may not have coverage for a specific condition that existed before enrollment.
New dental groups without a current dental plan must wait one year before purchasing orthodontic benefits.
What are the different funding mechanisms for employers?
Self-insured plans are financed entirely by the employer from employer funds. No insurance coverage is purchased from commercial carriers, so employers take on all risk for paying claims. Typically only large employers do this.
Fully-insured medical plans are purchased by an employer from a commercial insurer. The insurer takes on all the insurance risk.
For dental plans, HealthPartners also has employer-sponsored (non-contributory) and voluntary (contributory) options.
Contributory plans employer passes the cost of the premiums on to employees or uses cost sharing approaches.
Non-contributory plan employer pays the full premium and does not require employee cost sharing.
Do HealthPartners medical or dental plans require primary clinic selection?
HealthPartners offers a variety of plans, with and without primary clinic options. In many cases, primary clinic plans provide the best combination of benefits and premiums. HealthPartners also offers comparable plans that do not require primary clinic selection.
When should a group purchase stop-loss insurance?
Employers with self-insured medical plans put their assets at risk in the event of catastrophic claims. Stop-loss insurance offers protection against catastrophic or unpredictable losses by covering losses that exceed pre-specified limits called attachment points.
Through HealthPartners Insurance Company, a wholly owned subsidiary of HealthPartners Administrators, Inc., we offer self-insured employers two forms of stop loss coverage.
Specific stop-loss coverage limits the employers risk to high expenses on each covered family unit rather than the entire population. Specific-only or specific/aggregate coverage is available for groups of 50 or more.
Aggregate stop-loss coverage sets a maximum dollar amount employers would pay for all covered individuals during a contract period. This is referred to as the aggregate attachment point. The stop-loss carrier reimburses employers for amounts paid in excess of this attachment point after the end of the contract period. Aggregate-only coverage is available to groups of 1,000 or more.
What types of medical and dental plans are available?
HealthPartners offers a variety of medical and dental plans and products at competitive rates. For employers, we tailor provider networks, plan designs and benefit variations to their needs.
Our Group Plans provide various approaches to engaging consumers in making decisions based on the quality and cost of care. We also make it easy for employers to offer multiple plan options using a defined contribution approach. HealthPartners also offers plans for Individuals and Medicare-eligible individuals.
Where can I get forms?
Log on to your secure employer site or call your broker or your HealthPartners account representative.
How can I change my group's contact information?
Log on to your Employer site or contact your broker or HealthPartners account representative to change your contact information.
Who has access to medical records?
Medical records are held confidential and under law cannot be released to anyone outside of HealthPartners without the member's written consent.
Exceptions may include a release of information:
- If required by court order
- To medical personnel in a medical emergency
- As necessary to facilitate complaint investigations or investigations or inspections by the Minnesota Department of Health
- If otherwise required by federal or state law or contract of benefits
- To qualified personnel for research, audit or program evaluation, as long as individuals cannot be identified
Who can answer questions?
Contact your broker or review your Member Handbook. For administrative questions about medical and dental plans, benefits, claims, and other plan materials, e-mail Member Services.
How do I add a new employee?
Have the employee complete an application, including hire date and previous coverage, then submit the information to HealthPartners Membership Accounting. You can also enter the information directly if you Log on to your secure employer site.
HealthPartners will apply any employer-specified waiting period based on the hire date, after which the employee will receive membership materials.
When does an employee's coverage become effective?
Employees can enroll under a plan within 31 days after their eligibility date to obtain the desired effective date. Applications received more than 31 days after the eligibility date become effective on the first of the following month.
Under what circumstances can a member change his or her coverage?
Specified "life events" dictate when someone can change coverage. The employer defines which life events are approved. Typically these include such things as a change in marital status, the birth or adoption of a child, a change in employment hours, etc.
What does HIPAA mean to me as an employer?
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a wide-reaching and evolving piece of legislation that cannot be summarized here. Contact your legal advisors to determine your specific responsibilities under HIPAA. HealthPartners continually implements changes to comply with all HIPAA regulations.