Ask the Agent

Q: We have an employee who is not currently enrolled in our voluntary Disability plan, but who is thinking about enrolling for 2025. They have an active diagnosis for condition that does not currently require surgery. If they have surgery in 2025, would this situation be considered a preexisting issue and possibly exclude payment from the carrier?

A: It’s best to stay on the side of caution with these scenarios. If the employee requires surgery in 2025 and they are treating for it up until they enroll in the voluntary disability coverage, it most likely would fall under the pre-existing clause. We don’t know 100%. But it’s very safe to say that it’s at least probable. Many times, the carrier will seek medical records to verify ongoing treatments for any recent diagnoses. These situations can get complex and it’s always best to seek out the definition of any exclusions in your plan booklet.

Q: What is an Employee Assistance Program?

A: An EAP provides confidential services to employees who need help managing difficulties in life. EAPs have a wide range of concerns, including:

• Mental Health disorders

• Financial stress

• Marital or family problems

• Substance Abuse

• Legal Problems

• Caregiver Stress

EAPs help employees improve their health and wellness. In exchange, employers may experience better productivity and employee engagements.

Q: We provide insurance benefits to our employees, but we haven’t reported several staff changes to our insurance provider in a timely manner. What potential risk does this pose?

A: New employees – Most insurers require applications be submitted within 31 days of eligibility to guarantee acceptance without requiring evidence of the employee’s insurability. If the coverage is either fully or partially employee paid, it is assumed coverage has been waived when the application isn’t submitted in a timely manner. If the employee isn’t required to contribute towards the premium, all eligible employees must be insured and it’s possible that an exception could be granted for an administrative error. However, policies can differ by insurance carrier.

Terminated employees - Inform insurance carriers immediately so the premium billing can be discontinued, and ineligible claims will not be paid. Medical related plans are subject to Federal COBRA Continuation and Minnesota Law requires you offer Eighteen Month Continuation of Group Term Life coverage. You or a third-party COBRA administrator must send the written election notice(s) to the terminating or ineligible employee’s last known address within 14 days (Minnesota Law applying to fully insured plans) to avoid extending your liability. Former employees have a 60-day election period beginning on the later date their coverage is scheduled to end or the date they receive the election notice. If the former employee elect’s continuation and remits the premium within the required election period, inform your insurance carrier to retroactively restore COBRA/MN Continuation. If the former employee fails to respond within the 60-day election period, the option to continue coverage is no longer available and liability ends.

Q: Who is eligible for group health insurance on an employer’s plan?

A: To be eligible for group health insurance, an employee must be on payroll and the employer must pay payroll taxes. Individuals usually not eligible for group health coverage include independent contractors, retirees, and seasonal or temporary employees. Employees who are on unpaid leave are often ineligible for group coverage until they return to work. Additionally, family members and dependents can be added to group plans at an additional cost to members.

Q: What’s the best way for an employee to find out if a certain service is covered by their current health plan?

A: Typically, the easiest way to determine if a certain service is covered by the current health plan is to call the health plan’s member service department, which is typically located on the back of their health insurance card.

Q: When can an employee update the beneficiary information on their life insurance policy?

A: Employees can update this information anytime throughout the year, as needed. However, annual renewal season is a good time to remind your employees they may want to review the beneficiary designations for their 401K and Life insurance policies. Employees who have experienced a change in their family status such as marriage, divorce, or the birth or death of a family member may want to change their designations.

Q: What is the purpose of Open Enrollment for Health Insurance?

A: Although it can be frustrating to have a small window to enroll in health insurance, there are reasons for having the open enrollment period. If you knew that you could get health insurance whenever you want to, you might choose not to get it or get the cheapest plan available. Then, if your health changes, you could switch to a plan with better coverage. Health insurance was created to help people pay for health care costs. But the health insurance industry would go broke if people only paid for coverage when they suddenly needed coverage. Open enrollment for health insurance is an incentive for people to buy health insurance, choose the plan that fits their specific needs and get it in place before it’s needed.

Q: I have an employee who would like to make changes to their health and dental plans mid-year. Can they do this?

A:  Yes, if they have a qualifying life event. A qualifying life event is an event that triggers a special enrollment period for an individual or family to purchase health insurance outside of the regular annual open enrollment period.

A few examples of qualifying life events would include:

• Birth or adoption of a child
• Marriage or Divorce
• Loss of other coverage

*If no qualifying life event has happened, employees can change their elections on the January 1 plan anniversary date.

Q: An employee has two health insurances; how do they determine which health insurance is primary?

A: If the employee has children, primary coverage usually goes to the parent whose birthday falls first in the calendar year. If the employee has health insurance through their employer or other insurance, such as a spouse, theirs through their employer is primary.

Q: What is the difference between in-network and out-of-network providers and how does it affect health insurance?

A:  Most insurance plans partner with doctors to get better pricing and coverage for health services. Doctors and health centers that are partnered with the insurance plan are part of an “in-network” group. Doctors and health centers that are not part of this group are considered “out-of-network”. Out-of-network services usually have a separate deductible and out-of-pocket maximum that is higher than the in-network deductible/maximum. Because of this, out-of-network services often cost more or may not be covered by the insurance plan. Researching doctors, hospitals or other providers in advance can help save money and avoid surprise bills.

Q: What is coinsurance and how does it affect my health insurance?

A:  If coinsurance is listed in the coverages of your health insurance policy, the coinsurance percentage listed is the percent of the benefit expense which you, the insured, are responsible for. Example: If you have a 20% coinsurance and a $100 health care bill. You, as the insured, would owe $20.

Q: Should I change health insurance plans during open enrollment?

A: Not everyone needs to change their plans during open enrollment. But if you are currently looking to possibly reduce costs, change plans or are currently not insured, Open enrollment is the time to do it. Open enrollment runs from November 1 through December 15.

Q: An employee is inquiring about a dependent who is turning 26. Would this be considered a qualifying event for the employee to then change their current health insurance plan?

A: Having a dependent that is turning 26, would not be a qualifying event for the employee to change their own coverage. The employee would have to wait until the open enrollment period to change their current health insurance plan.

Q: An employee is inquiring about COBRA, due to termination of their employment.  If they choose the COBRA option, when does COBRA start and how long are they eligible to stay on COBRA?

A: Assuming the employee pays all required premiums, COBRA coverage starts on the date of the qualifying event, and the length of the period of COBRA coverage will depend on the type of qualifying event which caused the qualified beneficiary to lose group health plan coverage.

For “covered employees,” the only qualifying event is termination of employment (whether the termination is voluntary or involuntary) including by retirement, or reduction of employment hours.  In that case, COBRA lasts for eighteen months.
If the qualifying event is the death of the covered employee, divorce or legal separation of the covered employee from the covered employee’s spouse, or the covered employee becoming entitled to Medicare, COBRA for the spouse or dependent child lasts for 36 months.

Q: An employee would like to add her spouse to her dental policy, can we do this?

A: Yes, we can enroll him as the employees’ spouse on the dental plan if there is a qualifying life event. If no qualifying life event has happened, employees can change their elections on the January 1 plan anniversary date.

Q: A long-time employee has decided to terminate employment and pursue other interests. The employee has 20 weeks of vacation left. Can we terminate the group insurance plans when the vacation exhausts?

A: Group plans may vary in their allowance to extend coverage for unused PTO but most plans have strict hourly work requirements for participation. Extending active employee coverage for a few weeks for unused PTO may not be so problematic but extending coverage for large banks of unused PTO may not be acceptable to your insurance carrier. Check with your carrier to see if there is any allowance to extend active employee coverage before you consider the employee terminated and offer COBRA or Minnesota Continuation.

Q: If I terminate my employment, can I keep my healthcare benefits?

A: Yes. You should be eligible to qualify for COBRA health insurance. With COBRA, if you quit your job voluntarily, you are entitled to continue with your employer’s group plan at your own expense for up to 18 months.

Q: We are looking to enroll in some of the MBA’s offered insurance plans. Specifically Dental, Life and Disability. With renewal season upon us, do I have to enroll in all plans by 1/1/2022 to meet the deadline?

A: The MBA’s Dental and Vision plans must all enroll by 1/1/2022 to meet the required deadline. However, the Life and Disability plans can be added anytime throughout the year. If you are short on time, consider adding the Dental and Vision before the 1/1/2022 deadline. Then, later add the Life and Disability plans as it works for your bank.

Q: One of our employees has a daughter who was recently married. Is she able to stay on the employee’s current dental plan? If so, do we need to do a last name change?

A: The daughter’s marriage status does not impact her eligibility to stay on the current plan. She may stay under the current dental plan until she reaches age 26. Yes, if there is a name change it should be updated to keep plan records current and up to date.

Q: I enrolled in the MBA Dental Plan with Single Coverage during the Annual January Open Enrollment. Can I elect to add my spouse now to the plan? 

A: Your benefit elections are intended to remain the same for the entire Coverage Year. During the Coverage Year, you will be allowed to change your benefits only if you experience an eligible Family Status Change which includes:

 

• Change in legal marital status such as marriage or divorce.  
• Change in number of dependents in the event of birth, adoption, or death.  
• Change in your or your spouse’s employment - either starting or losing a job.  
• Change in your or your spouse’s work schedule, such as going from full-time to part-time or part-time to full-time or beginning or ending an unpaid leave of absence.  
• Change in dependent status when a child reaches maximum age under the Plan.  
• Change in residence or work location so you are no longer eligible for your current health plan.  
• Become eligible for Medicare, Medicaid, or Children’s Health Insurance Program (CHIP) coverage.  
• Termination of Medicare, Medicaid, or Children’s Health Insurance Program (CHIP) coverage because you or your dependents are no longer eligible.  
• Loss of other coverage.

Q: In addition to brushing and flossing, do sealants help reduce cavities in children?

A: Sealants have been shown to reduce the risk of decay by nearly 80% in molars. This is especially important when it comes to your child’s dental health. In October 2016, the Centers for Disease Control released a report on the importance of sealants for school-aged children, of which only 43% of children age 6-11 have according to the CDC. According to the CDC, “school-age children without sealants have almost three times more cavities than children with sealants”.

Q: Do I lose my HSA eligibility at age 65?

A: No. You can open and contribute to an HSA at age 65 or later as long as you meet HSA eligibility requirements, which are: 

• You’re covered on an HSA-qualified medical plan 
• You’re not someone’s tax dependent 
• You don’t have any conflicting coverage (including enrollment in any part of Medicare) 

Turning age 65 does not, in and of itself, preclude you from remaining HSA-eligible absent any disqualifying coverage.

Q: What are the new High Deductible Health Plan and Health Savings Accounts limits?

A: The IRS released the following 2021 limits for High Deductible Health Plans (HDHPs) and Health Savings Accounts (HSAs). 

2021 HSAs Contribution Limits: 

• Self-Only: $3,600 
• Family: $7,200 

2021 HDHP Minimum Deductible: 

• Self-Only: $1,400 
• Family: $2,800 

2021 HDHP Maximum Out-of-Pocket Expenses: 

• Self-Only: $7,000 
• Family: $14,000

Q:  I am currently pregnant and have mild gum disease.  Is it okay to have periodontal cleanings during pregnancy?

A: Gum disease, also called periodontal disease, is advanced inflammation of the gums that causes them to pull away from the teeth. The medical and dental communities concur that maintaining health is an important part of a healthy pregnancy.  Clinical recommendations released by the AAP and EFP state that non-surgical periodontal therapy is safe for pregnant women and can result in improved periodontal health.

Q:  Is there any filing that the employer needs to do for the annual Medicare Part D creditable coverage (or non-creditable coverage) notices?

A:  The employer must now file their notices directly with the Centers for Medicare and Medicaid Services (CMS). You can complete the Online Disclosure to CMS Form through the CMS website and refer to the “Disclosure to CMS Form” section for more information. Disclosure should be completed annually no later than 60 days from the beginning of a plan year (contract year, renewal year), within 30 days after termination of a prescription drug plan, or within 30 days after any change in creditable coverage status.

Note: Most health carriers mail Medicare Part D creditable coverage notices in September or October to subscribers. The notices are required by law and are designed to help Medicare-eligible individuals decide whether to retain their current prescription drug coverage, or to enroll in Medicare prescription drug coverage.

Q:  Our bank has the MBA Dental Plan and an employee has asked if they should get a pretreatment estimate for a permanent crown?

A:  It is recommended that a pretreatment estimate be submitted to the plan prior to the treatment if your dental treatment involves major restorative, periodontics, or prosthetic care. The pretreatment estimate is a valuable tool for both the dentist and the patient. Submission of a pretreatment estimate allows the dentist and patient to know what benefits are available to the patient before beginning treatment. The pretreatment estimate will outline the patient’s responsibility to the dentist regarding co-payments, deductibles, and non-covered services and allows the dentist and patient to make any necessary financial arrangements before treatment begins. This process does not prior authorize the treatment nor determine its dental or medical necessity. The estimated Delta dental payment is based on patient’s current eligibility and current available contract benefits.

Q:  We’ve heard a lot lately in the news about teenage vaping, use of e-cigs. Have you heard if this usage affects dental health?

A:  Science confirms your dental health is important to your overall health. Dental providers are seeing an increase in teenage patients with dry-mouth syndrome, also known as Xerostomia. They are attributing this to teenage vaping. For patients who use tobacco, in addition to the risk of developing lung cancer, smokers have twice the risk of developing gum disease compared to non-smokers. Half of severe gum disease cases in the United States result from cigarette smoking.

Q:  Both my spouse and I are employees at the same bank that has the MBA Dental Plan. Can we both have our own dental plans?

A:  If both you and your spouse are employees of the same employer, you may be covered as either an employee or as a dependent, but not both. Your eligible dependent children may be covered under either parent’s coverage, but not both.

Q:  Our bank has dental coverage through the MBA Dental Plan and we heard that the carrier, Delta Dental of Minnesota, also offers a hearing health care benefit. Would you please tell me more about this?

A:  Amplifon Hearing Health Care can help you find the solution that is right for you for hearing loss. They will find the solution that best fits your lifestyle and budget; provide one year free follow-up care, two years free batteries, and a three-year warranty. They also have a hearing aid low-price guarantee. For a free hearing screening, you can call 1-877-310-3053 or go online at www.amplifonusa.com/deltadentalmn.

Q:  I’m having dental surgery that is covered by the MBA Dental Plan with Delta Dental. Please tell me if the anesthesia connected with the surgery will be covered. 

A:  Intravenous conscious sedation is eligible as a separate benefit when performed in conjunction with complex surgical services. However, coverage is NOT provided for: Deep sedation/general anesthesia, analgesia, analgesic agents, anxiolysis nitrous oxide, therapeutic drug injections, medicines, or drugs for non-surgical or surgical dental care, regardless of the method of administration. Please note: It is recommended that a pre-treatment estimate be submitted to the plan prior to treatment for major restorative, periodontics, or prosthetic care. The pre-treatment estimate is a valuable tool for both the dentist and patient, allowing you to know what benefits are available before beginning treatment.

Q:  I have gum disease and have had periodontal cleanings in the past. Currently, I am five months pregnant and wondering if it is safe to have periodontal cleanings during pregnancy?

A:  The medical and dental communities concur that maintaining periodontal health is an important part of a healthy pregnancy. Clinical recommendations released by the AAP and the EFP state that non-surgical periodontal therapy is safe for pregnant women and can result in improved periodontal health.

Q:  Our bank is enrolled in the MBA Dental Plan. Employees are asking about their children’s oral health and have the following questions: 1) At what time/age should we add children to the dental plan? 2) At what age should children begin brushing and flossing?

A:  The MBA Dental Plan states children may be added to the program at the time the eligible employee originally becomes effective or may be added up to 30 days following the child’s third birthday. The child’s effective date will be the first of the month on or after their date of birth or the first of the month following receipt of a notice to add the child. Note: You should read your dental plan booklets as effective dates and eligibility can vary by other carrier plans.
Brushing: By age three, a full set of 20 primary teeth will be in place. Brush with a small amount of fluoride toothpaste, twice daily. For infants from birth to 18 months, clean gums with a soft clean cloth until teeth begin to develop. At 4-7 months, teeth will begin to erupt. Start brushing your baby’s teeth for two minutes, twice daily with a small amount of fluoride toothpaste.  
Flossing: Preschool, 3-5 years, when teeth begin to touch, children can begin flossing twice per week. At school age, they can begin flossing once daily.

Q:  We encourage employees enrolled in our dental plans to get preventive care. Do you know how much we may be saving in costs due to better oral health?

A:  Members who get preventive care tend to have better oral health and cost less than people who don’t get preventive care. A recent benchmark study showed that members who regularly see a dentist (at least once a year for the past two years) had total costs that were $485 less than those members with no oral exams. Members aged 6-19 with sealant visits had restorative costs that were $168 less than those with no sealant visits.

Q:  My dentist says I’m showing early signs of gum disease and need to have regular preventive care. Can you tell me more about gum disease?

A:  Gum disease, also known as periodontal disease, is a chronic bacterial infection that affects gums and bone that support your teeth. Gum disease is fairly painless until an advanced stage and is one of the most widespread diseases affecting adults. Gum disease can be prevented or easily treated if discovered early; but, left untreated, can lead to tissue, bone, and tooth loss. Numerous studies also suggest that gum disease may be associated with more serious health problems such as diabetes, heart disease, stroke and premature, low-weight births. Preventive care can help detect early signs of gum disease, often before it becomes painful or costly treatment may be required for treatment.

Q:  What happens to an eligible individual’s Health Savings Account (HSA) if they change jobs and the new employer does not offer an HSA qualified High Deductible Health Plan (HDHP)?

A:  The HSA belongs to the account owner, and they can continue to use it for qualified medical expenses. However, the account owner cannot make further contributions to the account because they no longer meet the requirements of an eligible individual.

Q:  I have an officer who has been transitioning into retirement for the past few years. He does some work for the board that amounts to a few hours a month and may also come into the office occasionally. Will this impact his life insurance through the MBA?

A:  The MBA Life Plan requires that employees work a minimum of 20 hours per week to be considered eligible. If a covered employee terminates employment, retires or reduces their hours below the plan’s 20 hour per week minimum they must be provided a written Eighteen Month Continuation election notice within 14 days to comply with Minnesota Statute 61A.091 (www.revisor.mn.gov/statutes/?id=61A.092). The former covered employee must respond to the election notice within 60 days of the later of the date their coverage under the MBA Group Plan expires or from the date they receive the election notice. If the former employee fails to respond to the election notice within the required 60 days or fails to make their monthly premium payment to their former employee by the end of each month, their coverage will be terminated. Please inform MBA in a timely manner of an employee’s terminations and/or election to continue their coverage.

Q:  I have Basic Life insurance through the MBA Life Plan and would like to know if I can list my minor child as a beneficiary? What happens if I don’t name a beneficiary?

A:  If a beneficiary is a minor at the time the insurance proceeds are payable, the proceeds will be disbursed in one of the following ways:

1. To the legal guardian of the minor beneficiary’s financial assets;
   
2. To an adult responsible for the well-being of the minor beneficiary if permitted under any applicable Uniform Transfer to Minor Act; or
   
3. The insurance proceeds will be held by the carrier until the minor beneficiary is of legal age (based upon state law) to receive the payment.

If there is no named beneficiary, the proceeds will generally be paid to the first of the following:  the surviving spouse; surviving children in equal shares; surviving parents in equal shares; surviving siblings in equal shares; the estate.

Q:  I have a High Deductible Health Plan (HDHP) and own a Health Savings Account (HSA). My spouse is over 65 and receives Medicare and Social Security Benefits. Can the account owner be reimbursed from the HSA for the spouse’s co-pays and other medical expenses?

A:  The spouse’s qualified expenses can be reimbursed from the HSA because the spouse’s other coverage does not affect the account owner’s eligibility. However, the spouse is not eligible to open or contribute to his or her own HSA.

Q:  At what age can we add our first child to the MBA Dental Plan? Also, does the plan cover fluoride treatments and sealants for children?

A:  Children may be added at the time the eligible employee becomes effective or may be added anytime up to 30 days following the child’s third birthday.
Fluoride treatments are covered one time per 12-month period and help protect teeth against future tooth decay. It is also found in drinking water and toothpaste. Sealants are covered one time per lifetime for permanent first and second molars of eligible dependent children through the age of 15. Sealants are plastic coatings that protect difficult-to-reach pits and grooves on the chewing surfaces of the teeth from the bacteria that cause tooth decay.

Q:  Our MBA Dental Plan gives us the option to choose a dentist from the Delta Dental PPO, the Delta Dental Premier Network or Out-of-Network. The premium cost remains the same regardless of the network utilized, but can you tell me how the savings differ by network?

A:  Delta Dental offers the nation’s largest network of dental providers, delivering greater access to care and more cost savings. Here’s how the savings differ:

Exceptional Savings – Delta Dental PPO: lowest out-of-pocket cost; significant discounts; no balance billing and no paperwork.
Great Savings – Delta Dental Premier: largest network; low out-of-pocket cost; moderate discounts; no balance billing and no paperwork.
No Savings – Out-of-Network: highest out-of-pocket cost; balance billing; no discounts.

To find a network dentist, go to www.DeltaDentalMN.org. For more information about the MBA Dental Plan, contact Connie Mack at connniem@minnbankers.com.

Q:  We currently give each of our employees $500 annually towards their dental expenses. What would be the benefit of offering a group dental plan?

A:  The money you are giving to your employees is after tax. A group plan would provide before tax benefits for the employee as well as any dependents that they may wish to cover. A group plan also affords the opportunity for discounted rates on all dental services. The MBA Dental Plan has four plan options ranging from $1,000 to $2,000 annual maximums per person with preventive care covered at 100 percent. The cost to cover your employee under one of these options ranges from $393 to $532 annually. You could save money and provide greater benefits! Please contact me and I can walk you through your options.

Q:  How will my benefits be paid if I receive both preventive and non-preventive care at my visit? Also, could you give me some examples of what is considered preventive care?

A:  If you receive both types of care (preventive and non-preventive) at your visit, the preventive services will be covered at 100%. You’ll pay a share of the costs for the non-preventive services. Preventive services generally can help keep you healthy: screen for certain types of cancer, immunize you against disease, and are received once per year as recommended by your doctor. The Affordable Care Act defines what’s considered preventive care. You can learn more about what’s covered on the Health & Human Services website at HHS.gov/healthcare and by searching for “preventive services.”

Q:  I have a small group medical plan eligibility question. Can you please tell me what type of entity qualifies as a small group?

A:  The following type of entity qualifies as a small group:

• Must be headquartered and actively engaged in business in Minnesota.
• Must employ at least one common-law employee to whom the coverage will be made available. For instance, if the entity is a sole proprietorship or partnership under which the only enrollees would be “non-bona fide” partners (and/or their dependents), or a corporation under which the only enrollees would be non-common law employee-shareholders/owners, then the entity is not eligible for group coverage.
• Must employ at least one common-law employee and fewer than 51 full-time equivalent employees.
• Must offer coverage to all eligible employees working the defined hours-per-week requirement without any additional classification restrictions. The defined hours-per-week requirement must be at least 20 hours per week.
• Must have at least one eligible employee enrolled in the group plan. (Check your contract; some carriers might require two employees.)
• Must contribute at least 50% of the premium for employee coverage and there must be a minimum participation of 75% of all eligible employees (after eligible waivers are excluded). These two requirements do not apply during the annual open enrollment for small employers from November 15 to December 15.

Q:  We have dental coverage with the MBA Dental Plan and I'm questioning at what age we need to add children to our plan.

A:  Dependent children are covered from birth up to the age of 26. A child may be added to the Program at the time the eligible employee originally becomes effective or may be added any time up to 30 days following the child's 3rd birthday. If a child is born or adopted after the employee's original effective date, such child may be added anytime between birth (or date of adoption) and 30 days following the child's 3rd birthday. In the event that the child is not added by 30 days following their 3rd birthday, that child may be added only if there is a Family Status Change or at an open enrollment.