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Insurance FAQ's
WHO IS ELIGIBLE FOR GROUP HEALTH INSURANCE?
Current business members and their eligible employees may apply for group health coverage(s) through the Chamber. Member companies must maintain a current membership with the chamber in order to continue receive access to group health insurance through the chamber. (top of page)
WHAT PAPERWORK IS REQUIRED TO BE COMPLETED BY EMPLOYERS?
First, New York State insurance regulations require that businesses enrolling in group health coverage through a Chamber or Association show that they are authorized to do business in the State of New York (i.e., by providing a dba certificate, partnership or incorporation papers) and show income from the business (by providing Schedule C information from prior tax year or NYS 45, quarterly withholding report showing employees for corporations).
Each insurance company requires the member company complete an Employer Application at the time of enrollment. Employers need only complete the Employer Application associated with the carrier employees are enrolling. (top of page)
WHAT PAPERWORK IS REQUIRED TO BE COMPLETED BY EMPLOYEES?
Applications for health coverage may be obtained on this website or from the Chamber. Eligible employees are to complete (in full) an application for the appropriate coverage selected and return it to their employer for approval and submission to the Niagara USA Chamber. Refer to each carriers page for specific submission materials. (top of page)
WHO IS CONSIDERED AN ELIGIBLE EMPLOYEE?
Eligible employees are defined as those employees who work 20 hours or more per week, or satisfy the eligibility criteria defined by the member company. Member companies who follow different eligibility conditions must disclose this criteria in writing prior to enrolling in benefits. (top of page)
HOW DO I FIND OUT ABOUT THE PLANS AVAILABLE?
Benefit summaries (2010 Health Insurance Rates and Plans) are available on this website or at the Chamber of Commerce. (top of page)
WHEN CAN WE ENROLL IN GROUP HEALTH COVERAGE?
New member companies must enroll no later than the 1st day of the month following 30 days of hire. Sole Proprietors are eligible to enroll no later than the 1st day of the month following 60 days of Chamber membership. (top of page)
ARE THERE OTHER TIMES DURING THE YEAR THAT WE MAY ENROLL?
Generally, Open Enrollment is the only opportunity you may enroll or change existing health coverage. Your Chamber will notify you of this opportunity through regular mailings. As a consumer you should take advantage of the opportunity to learn about the changes in plans, rates and enrollment requirements by attending the open enrollment sessions. (top of page)
CAN I MAKE CHANGES TO MY EXISTING COVERAGE DURING THE YEAR?
Generally, changes in family status or qualifying events will permit existing subscribers to make changes in response to the qualifying event. Changes in status, or qualifying events include, but are not limited to: birth of a child, QMSCO's, marriage, divorce, legal separation, loss of coverage through another source (such as a spouse). If you lose coverage through another source, such as a spouses plan, you may enroll in coverage through the Chamber, as long as your employer is a current member of the Chamber and you enroll within 30 days of the date of the loss of coverage.
Documentation to support your qualifying event will be required to accompany your application. For example, if you become married, we will request a copy of the marriage certificate or other form of validation indicating the date the event took place.
Changes to existing health plan coverage must be made within 30 days of the date of the event by submitting a completed application to the Niagara USA Chamber. (top of page)
WHEN MUST APPLICATIONS BE RETURNED TO NIAGARA USA CHAMBER?
For new hires or new member companies (and any eligible employees) applications are due at least three (3) weeks prior to the effective date of coverage. For new enrollments, premium payment MUST accompany all applications being submitted to Niagara USA Chamber. (top of page)
HOW DO I TERMINATE COVERAGE?
Written request to terminate coverage is required. You may fax your request to 285-0941. Termination requests must include the persons name and the last day of the month in which coverage is to terminate. Terminations must be received no later than 30 days from the date coverage is to end. (top of page)
HOW DO I DROP A DEPENDENT?
In the event you must drop a dependent due to death, divorce or a qualifying event, an enrollment form must be completed and sent to Niagara USA Chamber within 30 days of the event. You must also submit a copy of documentation to support the qualifying event, such as the 1st and last page of the divorce decree with enrollment change form. Documentation must accompany the enrollment form in order for the change to be processed by the insurance company. (top of page)
WHEN WILL I RECEIVE MY HEALTH INSURANCE INVOICE?
The Billing Schedule will generally be issued five (5) weeks prior to the calendar quarter for quarterly payees, with payment due dates clearly marked on your invoice. During open enrollment and annual rate adjustments, the billing schedule will often be delayed. You should visit our website to check for billing schedule changes or updates. (top of page)
WHERE DO I MAKE MY INSURANCE PAYMENTS?
All payments are to be sent to EBS-RMSCO at:
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