YOU GOTTA LAUGH:
Life in the Trenches of the Health Insurance Business
By Stephanie Cohen and Scott Golden
This Month’s Insurance Nightmare: Your employer enrolled you in the company plan, but you did not receive the cards for two months and are not listed on the bill.
The Situation: An employer named J.J. hired Bill on October 16. The waiting period established by J.J.‘s plan begins the first of the month following the hiring date of the employee. Therefore, the effective date of Bill’s family’s coverage is November 1. However, Bill did not get an insurance card, and J.J.’s bill for November does not reflect the fact that Bill has been added onto the plan. Understandably, J.J. is upset because he does not want to pay for the month of November since Bill cannot use the company health insurance plan that month, as his coverage was not reflected on the November bill.
The Solution: There is always a time lag between the date that an application is submitted to the time a card is sent to the employee and the bill is adjusted. Employers should estimate that the process takes two months. And cards can take up to three weeks to be received by the new employee.
To avoid confusion and frustration, employers need to explain to newly hired employees that they have coverage on the effective date, but they will probably not have a card in their hand for several weeks.
A phone call to the insurance company can confirm that the employee’s application is being processed. Also, keep copies of all correspondence, emails and faxes to prove when the application was sent and received by the insurance company.
If We were the Health Insurance Ambassadors: We would rid the world of those pesky insurance cards. Instead, there could be a website that the provider could access showing the application was received, and being processed. This would be a much more efficient and less costly strategy for the insurance company — and a stress-free solution for the consumer.
The Painful Truth: The reality is that there is a time lag for insurance companies to process an application, regardless of whether it is online or paper. Bills are often not correct, and it would be better to retroactively charge employers for more than one month of premiums to make up for the time lag.
Employers: Be prepared for incorrect bills and a delay in receiving insurance cards. However, if the waiting period is met after the date of hire, the employee is covered and thus, the premiums MUST be paid regardless of the lack of card or bill. If not, the insurance company is liable and on the hook for any expenditures incurred.
About Scott Golden, Chief Financial Officer
Golden & Cohen
Scott Golden is recognized as an industry leader in the small to mid-size insurance market, and ranks among the area’s top producers according to the Washington Business Journal’s Annual List.
He received a BS in Marketing from the University of Maryland in 1985, an MBA from George Washington University in 1990, and later a JD and LLM in taxation from the University of Baltimore. His advanced academic and legal degrees enable him to evaluate local and national mandates in conjunction with helping his clients prepare and implement the proper strategy.
Supporting the community is important to Scott, who advocates about the importance of lower health care rates on behalf of his clients. He has served on the Green Acres School Board of Trustees and sits on the board of ALS-DC in Maryland.
Scott is a native of upstate New York. He has been married to Golden & Cohen co-owner Stephanie Cohen since 1989. They have two children.
About Stephanie Cohen, Chief Executive Officer
Since co-founding the Gaithersburg, Md., health care benefits firm Golden & Cohen in 1992, Stephanie Cohen has helped it grow into one of the largest female-owned companies in the Washington metropolitan region.
With more than two decades of experience in small group health insurance, disability programs and life insurance, she was a finalist for the Ernst & Young Entrepreneur of the Year Award, serves on the prestigious United HealthCare, Coventry, Aetna and Kaiser Broker Council. She is also a member of the Women’s President Organization, the District of Columbia Insurance Commissioner Advisory Council and The Greater Washington Health Underwriters.
A native of Maryland, Stephanie earned a B.S. in marketing from the University of Maryland in 1986. She has been married to Golden & Cohen co-owner Scott Golden for 20 years. They have two children.