Q&A: Employer Group Coverage

If the application is complete, the employee will be enrolled and an ID card mailed to the employee's address within two to three weeks from the time we receive the application. If the application is incomplete, enrollment will be delayed until we receive the necessary information.

Try to review each application to ensure it’s complete before sending it to Dean Health Plan. Pay special attention to:

• Hire dates
• Social security numbers
• Birth dates
• Primary care providers election (Not required for Point Plans)
• Signature and date
• Phone number

The phone number isn't required, but it is helpful since Dean Health Plan makes welcome calls to new members to explain benefits and answer any questions. Applications that are not signed or dated will be returned to the employee. This may delay the application unnecessarily, so please double-check this section before sending applications to us.

The "yellow employee copy" of the Group Application Form can be used as a temporary identification card until he/she receives the ID card. Temporary ID cards are also available by logging into DeanConnect. Providers can also call Dean Health Plan’s Customer Care Center to verify the coverage date of the employee/dependent.

A special enrollment or qualifying event is an event that allows an employee to enroll in the insurance plan after having initially waived the coverage, or allows an employee to add a spouse or dependent(s) to his/her plan. Qualifying events are sometimes referred to as "life events" or "family status changes."

When a loss of other coverage occurs, only the employee and/or dependents who were covered by this other group plan immediately prior to the termination of the coverage are eligible to apply for coverage by Dean Health Plan. The employee may not add any dependents who were not previously covered under the prior health plan.

You can terminate an employee's coverage with Dean Health Plan by:

• Mailing or faxing a memo to the Enrollment Department with the employee's name, social security number and date of termination.
• Making a note on the monthly billing statement.
• Having the employee complete a Group Application Form and send it to our Enrollment Department. However, Dean Health Plan does not require this form to terminate an employee's coverage.

Dean Health Plan will refund or adjust premiums for retroactive terminations for up to three months. The month the request for retroactive termination is received is counted as one month.

We prepare bills at the end of the month before the mailing date, which is about the second week of the month prior to the coverage month. Therefore, for changes to be processed and noted on the next billing statement, they must be received by Dean Health Plan no later than the 20th of the month prior to the mailing date.

For example: if changes are received by February 20, they will be noted on the April bill, which is mailed approximately the second week of March.

As the employer, you are responsible for notifying your employees and their dependents in writing of their rights to COBRA and Wisconsin continuation coverage. Therefore, you must be familiar with which events are qualifying events for group continuation to be offered to an employee or dependent.

And if your employee or dependent chooses to continue coverage, you need written documentation of their decision to continue. So you need to know the time guidelines that an employee has to elect group continuation.

You are also responsible for collecting the monthly premium payments from the employee or dependent and then paying Dean Health Plan. Again, you will need to know the guidelines regarding when payments can be required from the employee or dependent and when a person can be terminated for nonpayment of premium.

Dean Health Plan will notify the employee/spouse/dependent by sending a letter several months prior to the end of their group continuation coverage. The letter states when the coverage will end and the options for purchasing conversion health insurance available to the employee/spouse/dependent through Dean Health Plan.

You can forward any questions regarding plan options after group continuation to the Dean Health Plan Customer Care Center.

Sixty days before your anniversary date, you will receive your renewal package. For example, if your anniversary date is January 1, we will mail or deliver your renewal package by November 1. This package includes your renewal rates, benefit changes sheet and plan documents such as the Health Service Agreement, Member Certificate and Schedule of Benefits for your upcoming contract year.

If you need the renewal prior to the 60-day mailing date for budgeting purposes, note this on the RRF or call your Account Manager.

Call the Dean Health Plan Medicare representative at (608) 827-4189, or toll free at (800) 356-7344, extension 4189. You may also be able to determine answers by contacting your Account Manager.

Dean Health Plan's Customer Care Center is available to answer your questions Monday through Thursday, from 7:30 a.m. to 5:00 p.m., and Friday, 8:00 a.m. to 4:30 p.m. Just call (800) 279-1301. You can also call your Account Manager.