Employees

Consumer Protections Against Surprise Billing through the No Surprises Act

The No Surprises Act protects people from getting surprise medical bills when they have an emergency, get services from an out-of-network provider at an in-network facility, or get services from an out-of-network air ambulance service provider. It also establishes a process for payment disputes between plans and providers. It provides new opportunities for dispute resolution for people who are uninsured or self-pay individuals when they receive a medical bill that is much greater than the good faith estimate they get from the provider. If you have private health insurance, the new protections - which started in 2022 - will ban most types of surprise bills. If you're uninsured or decide not to use your health insurance for a service, you can get an estimate of the cost of care before your visit. If you disagree with your bill, you may be able to dispute the charges. Here are some frequently asked questions about the No Surprises Act:  Am I protected against surprise medical bills? Starting in 2022, the federal No Surprises Act (NSA) established new protections that prevent surprise medical bills for individuals covered under group and individual health plans. These new protections ban the most common types of surprise bills. What types of surprise medical bills does the No Surprises Act protect against? The No Surprises Act protects people covered under group and individual health plans from receiving surprise medical bills when they receive: most emergency services; non-emergency services from out-of-network providers at in-network facilities; and services [...]

Qualifying Life Events (QLEs) – Terminating Coverage

Throughout the year your circumstances may change which may make you eligible for a Special Enrollment Period (SEP).  If you have a baby, you or your dependent gain or lose other coverage, etc., you may be able to change your plan, enroll in a plan for the first time, add or drop family members, or terminate your plan. You must report the event WITHIN 30 DAYS of the event to be eligible for an SEP. Once you report the event in your account, DC Health Link will guide you through the options available to you and your family. Step 1: Report the Qualifying Life Event In each employee's account, consumers will have the option to report a qualifying life event. Please select the life event that applies to the primary subscriber or dependent (For Example: "Drop coverage due to new eligibility"). Note: There are three different pages of QLEs that can be viewed by clicking the arrow Step 2: Enter the Date of QLE Report the date of your qualifying event by selecting the date from the calendar or keying in the date. Then click "Continue". Step 3: Confirm the QLE If you are eligible to apply for a SEP, a green confirmation box will appear. Click "Continue" to proceed. Step 4: Confirm Household Once you have confirmed your household, click the "Continue" button. Step 5: Select Waive Coverage Click "Waive Coverage" for the plan that you wish to terminate. Step 6: Select Waiver Reason Select the reason why you [...]

Qualifying Life Events (QLEs) – Removing a Dependent

Throughout the year your circumstances may change which may make you eligible for a Special Enrollment Period (SEP).  If you have a baby, you or your dependent gain or lose other coverage, etc., you may be able to change your plan, enroll in a plan for the first time, add or drop family members, or terminate your plan. You must report the event WITHIN 30 DAYS of the event to be eligible for an SEP. Once you report the event in your account, the Health Connector will guide you through the options available to you and your family. Step 1: Report the Qualifying Life Event In each employee's account on www.MAhealthconnector.org, consumers will have the option to report a qualifying life event. Please select the life event that applies to the primary subscriber or dependent (For Example: Divorced or ended domestic partnership, Drop Family Member due to new Eligibility). Note: There are three different pages of QLEs that can be viewed by clicking the arrow Step 2: Enter the Date of QLE Report the date of your qualifying event by selecting the date from the calendar or keying in the date. Then click "Continue". Step 3: Confirm the QLE If you are eligible to apply for a SEP, a green confirmation box will appear. Click "Continue" to proceed. Step 4: Update Household You will be able to add/remove any members of your household. In the next steps you will have the option to add/remove any dependent from the policy without [...]

Qualifying Life Events (QLEs) – Adding a Dependent

Throughout the year your circumstances may change which may make you eligible for a Special Enrollment Period (SEP).  If you have a baby, you or your dependent gain or lose other coverage, etc., you may be able to change your plan, enroll in a plan for the first time, add or drop family members, or terminate your plan. You must report the event WITHIN 30 DAYS of the event to be eligible for an SEP. Once you report the event in your account, the Health Connector will guide you through the options available to you and your family. Step 1: Report the Qualifying Life Event In each employee's account on www.MAhealthconnector.org, consumers will have the option to report a qualifying life event. Please select the life event that applies to the primary subscriber or dependent (For Example: Married, Had a Baby, Lost or will soon lose other Health Insurance). Note: There are three different pages of QLEs that can be viewed by clicking the arrow Step 2: Enter the Date of QLE Report the date that of the qualifying life event. Step 3: Confirm the QLE Click "Continue" to proceed. Step 4: Add Member to Household Adding a member to the household does not add them to the policy, in the next steps you will have the option to add/remove any dependent from the policy. Step 5: Enter dependent information Enter the date of birth, gender and relationship to primary. Check the "NO SSN" box if the SSN is [...]

New Employers – How to Offer Health Coverage through the Health Connector

Who is this guide for? Employers who offer coverage through the Health Connector for the first time. New employers may be offering health coverage to their employees for the first time, OR they may have previously offered employer-sponsored coverage outside of the Health Connector. Get Started - Setup Your Account Click on the "CREATE ACCOUNT" menu and select "Employers". Or, click here now to create an account. Create Your Employer Account Fill out your email address and create a password (8 characters minimum) and then click the "CREATE ACCOUNT" button. NOTE: Please be sure that you record your password somewhere secure. You'll use your email address as your login in the future. Next, provide some basic information about you and your business. As the point of contact for the small business, provide your name and date of birth. Then, provide information about the small business, including company legal name, DBA name, federal employer identification number (FEIN), entity kind, and primary office location then click the "Create Employer" button. If you have more than one office location click "Add Office Location" and fill in the information for your other location(s) before proceeding to "Create Employer". NOTE: Brokers setting up accounts for Employers MUST use the information for the POC for the business and not their own information when filling out this section. Add Your Eligible Employees to Roster Creating Your Employee Roster: IMPORTANT - Make sure that the date of birth and SSN is accurate for each of your employees. [...]

New Employees – How to Enroll in Health Coverage through the Health Connector

Who is this guide for? This guide will walk employees without a Health Connector account through setting up their employee account, selecting a plan, or waiving coverage. Get Started - Setup Your Account Go to the Create Employee Account page fill out your email address and create a password (8 character minimum) and click the "Create account" button. Please be sure to record your password somewhere secure. You'll use your email address as your login in the future. Your Information and Matching to your Employer Your Information - Step 1: Fill out your personal information (name, DOB and SSN) and then click the red "CONTINUE". Your Information - Step 2: The Health Connector will match you to your employer by verifying your date of birth (DOB) and Social Security Number (SSN). Click "Continue" if the employer information displayed is correct. NOTE: If you are not matched to an employer, confirm you have entered your SSN and DOB correctly above. If you are still not matched to your employer, confirm your employer has your correct SSN and DOB and that you have been added to the employee roster. Your Information - Step 3: Fill out your contact information where needed, such as your address, email address, and phone number. The pre-populated information was submitted by your employer but may be edited by you. NOTE: By default, you opt into receiving electronic communications. To change this selection, select "only paper communications" or "paper and electronic communications" from the dropdown menu at the [...]

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