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WSBA Group Insurance "Q&A"

Q. I have Medicare A&B. How does that affect my coverage with the WSBA?

A. The WSBA medical plan is subject to the Tax Equity and Fiscal Responsibility Act (TEFRA). This means that the Group Health plan pays BEFORE Medicare pays. In order to avoid possible claims difficulties with Medicare, you should make your providers aware of this.

Q. My son goes to college out of state. How is he covered?

A. On three of the four Group Health plans, there are “out of network” benefits available. Emergency services are covered “in-network”. Additionally, if he is living in an area served by Kaiser Permanente, he can access “in-network” benefits on all of the plans due to Group Health’s cooperative agreement with Kaiser.

If he has dental coverage with the program, he can obtain “in-network” coverage with Delta Dental dentists all over the country.

Q. When can I change my medical plan?

A. Groups may change medical plans at open enrollment each year. This year, Group Health is allowing changes both on June 1st and July 1st. Open enrollment for 2006 will be on June 1st.

Q. I am already enrolled. Can I add other family members to the program outside of open enrollment?

A. Yes, under some circumstances you may add family members to the program during the plan year. These circumstances include change in family status such as marriage, birth and adoption. You may also add family members if they lose other group coverage, such as through your spouse’s employer.

Q. I have an employee who is leaving my company. Is there any continuation of coverage available for small groups?

A. Yes, if your group has fewer than 20 employees and is not subject to federal COBRA provisions, you may still offer your former employee a three month extension on the Group Health medical program. The former employee would pay the appropriate premium to your company.

Q. We’re interested in other coverage such as disability income protection. Is that available through the WSBA?

A. Not through the WSBA at this time (Watch for future offerings!). However, USI can help you with any of your insurance needs. Please call for assistance.