Forms
> Where can I download forms on your
Web site?
Visit the Download Forms page.
Here you will be instructed to select your group number range and
you will be directed to the correct forms you need. Please
note: If you are not yet enrolled in an Allied plan, you need
to contact your agent or
Allied Sales Support to find an agent in order to access the
correct forms and enroll your group.
> How can I submit applications?
Applications can be submitted by mail,
fax, or email to our Underwriting
Department.New Employee
>
I just hired a new employee. What do I need to
do right away for them?
Have your employee complete an application on the date of hire.
Regardless of your new employee waiting period, it is very important
that an employee wanting coverage fill out an application form
completely, the date they are hired. Submit the application
immediately. Waiting to fill out an application or not filling out
an application completely could delay your employee’s start of
coverage, reduce their benefits or cause them to be ineligible for
coverage entirely. We will process the application promptly, but
will not
bill for the new employee’s coverage until they become effective.
>
What if my new employee doesn’t want insurance
coverage?
Waivers must be completed for all eligible employees and/or
dependents not applying for coverage.
An employee who doesn’t enroll for coverage or fails to complete a
waiver could jeopardize his or her future rights to coverage.
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Eligibility
>
Which of my employees are eligible for coverage?
Please refer to your Certificate of Insurance for the specific
eligibility requirements for employees and dependents for your
group.
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Group Participation
>
What are the group participation requirements?
A minimum of two participating employees is required at
all times. A minimum participation of 75% of eligible employees is
required at all times. Any employee or dependent waiving coverage
because of qualifying existing coverage is not counted. If, for any
reason, your group falls below these minimums, you will have a fixed
period of time in which to reestablish minimum participation
requirements and avoid termination. See your Certificate of
Insurance for details.
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Premium
Payments
>
How and when do I pay premiums?
Our premium billing notices are mailed around the 15th of the month
prior to the month due. Premiums are due on the 1st of each month
(with a 31 day grace period in which to pay). Each bill you receive
will show the current premium and fees due, any charges or credits,
and any past due amounts shown as “Unpaid Prior Month.” If this
“Unpaid Prior Month” charge is not paid to Allied within the prior
month’s 31-day grace period, coverage will lapse as of the premium
due date for the unpaid month.
A separate fee on your billing called “Administration/PPO Fee”
covers the cost of administering your coverage (billings, insurance
records, etc.) and any applicable charges for access to your PPO
network of providers. You will be notified in advance of any changes
in premium rates.
Premiums do not need to be sent for new applicants until you are
billed. We will not bill for their coverage until the first month of
coverage begins.
When paying
your premiums:
• Please make checks payable to Allied National and include the stub
from the premium notice in the envelope provided.
• Premium payments MUST be made with your company/ business check.
Personal checks cannot be accepted. Mail payments to our
Premium Department.
Any check returned by your bank as non-negotiable will be treated as
if no premium payment has been made. Negotiable funds must be
received within the grace period or coverage will lapse. Your
account will be charged a fee for the nonnegotiable check.
>
What will happen if my premium payment is
delayed?
You are given a 31-day grace period in which to pay your premiums,
however there are several things that may happen if you delay your
payment.
• If a doctor or hospital calls Allied to verify your employee’s
coverage, the customer service representative at Allied is required
to disclose the group’s paid-to date. If your payments are not
current it may affect your employee’s access to medical care.
• Claims submitted for service dates within an unpaid month will be
pended until your account is brought current.
• If something should happen to your check (e.g. unsigned, doesn’t
clear bank) your premium will be considered unpaid until the matter
is resolved. If it isn’t resolved by the end of the grace period,
your coverage will lapse.
>
What if my coverage lapses?
Please contact Allied immediately if you receive a lapse notice. We
will review any options you may have to retain your coverage.
> How do I request
reactivation in coverage?
Contact Allied and we will review your
situation and discuss your options
to reactivate your coverage.
> Do you accept credit/debit card payments
over the phone?
We do not accept payments over the phone
for group benefit plans. Only for our Allied Short Term
Medical PLUS do we accept a credit card payment by phone.
> Can I make payments online?
Currently, we do not have a way for you to
submit your premium payments online.
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Changes to Coverage
>
When can I make changes to my group’s benefits
or coverage?*
Pregnancy Benefit:
Addition or deletion of pregnancy benefits can be done for any
qualifying group on January 1st or any rate renewal date with a
timely written request. We must receive the request within 30 days
of the renewal date, and it must be signed by an officer, owner or
partner of your firm. A federal mandate requires employers with 15
or more employees to offer pregnancy benefits. After issue, any
group that grows to 15 or more employees may also add pregnancy
coverage within 30 days of reaching the required number of
employees. The effective date will be the first of the month
following receipt of a valid written request.
Life Insurance:
Changes or additions can be requested on any premium due date. A
written request and an
Evidence of Insurability application for each
employee must be received prior to the requested effective date.
Changes and additions are subject to underwriting approval.
Coinsurance, Supplemental Accident, Employee Waiting Period**
or Occupational 24 Hour Coverage:
Changes, additions or deletions can be done on any premium due date
provided we receive a written request prior to the requested
effective date. Changes are subject to underwriting approval.
*Your Health Plan may not have all these options available. Please
contact your agent or Allied’s Customer Service team with questions
about potential changes. Once an employer terminates an optional
benefit, that optional benefit cannot be added again for any reason.
**Changes apply only to employees hired after the change date.
>
What if there is a change to my company name
or address?
A company name change requires written notification signed by a
company owner, officer or partner.
A company address change also requires written notification, which
can include marking the change on your premium notice remittance
stub. When writing, please include old and new addresses.
>
What if an employee wants to make a change?
Changes that do not involve the addition of a dependent:
Insured employees can submit a written request for a name change,
deletion of dependent coverage, etc. by notation on the reverse side
of the premium billing remittance stub, completing an
Employee Change Request form or writing a letter describing the
action to be taken.
Addition of dependents:
A new spouse is eligible for coverage the first of the month
following the date of marriage if a completed application is
received by Allied within 31 days of the date of marriage. Children
of the newly acquired spouse may also be eligible at this time.
A spouse also becomes eligible for coverage following the birth,
adoption or placement for adoption, of a dependent child if a
completed application is received by Allied within 31 days of the
birth, adoption or placement for adoption.
A newborn or newly adopted child is eligible for coverage from the
day of birth or adoption if a completed application is received by
Allied within 31 days of the birth or adoption.
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Termination
>
How do I terminate an employee’s coverage?
1. Complete the section on the back of the remittance stub titled
“Insured Changes” showing the full name of the employee, description
of the change requested (i.e. termination) and the
date of the change (i.e. date employee last worked). If coverage is
canceled, but the employee is still working with your company,
please have them complete a waiver.
2. Sign the back of the remittance stub to authorize the requested
changes.
3. Deduct the premium charge only if the employee terminates prior
to the current month’s billing cycle and prior to the “coverage
from” date on your billing statement.
If an employee worked even one day of the month, your policy
requires that premium MUST be paid for the employee that month.
Therefore, if an employee is terminating, notify Allied of the
change on the back of the remittance stub in the last month they
work, give the date terminated, but do not take a deduction for that
month.
Tip: For faster service, send Allied an e-mail or fax notification
of termination.
>
How do I terminate a dependent’s coverage?
Insured employees can submit a written request for deletion of
dependent coverage by notation on the reverse side of the premium
billing remittance stub, completing an
Employee Change Request form or by writing a letter describing the action to be taken.
>
Should I adjust my billing for adding or
terminating employees or dependents?
• DO NOT adjust your billing if you are terminating a dependent.
Allied will automatically extend credit due on the next bill
processed after the effective date of the change.
• DO NOT pay premiums for the addition of employees or dependents
until you are billed by Allied.
>
Can coverage continue through a leave of
absence?
Yes, insurance may be continued during any period the employee is
absent from active, full-time work due to an injury or illness. The
length of absence is determined by the employer's established leave
of absence provision. Insurance can also be continued during a
temporary layoff up to three months. Premium must be paid during this time. Please
send written notification to Allied immediately after granting any
leave.
>
Can coverage continue after an employee is
terminated?
The continuation of coverage provisions under the Consolidated
Omnibus Budget Reconciliation Act of 1985 (COBRA) requires some
employers* to offer covered employees and dependents continuation of
their group health care coverage for a specified period of time if
coverage is terminated due to certain qualifying events. Some states
also require continuation of coverage for employers not subject to
COBRA.
In no event will the COBRA continuation period extend beyond 36
months, even though more than one qualifying event has occurred. If
more than one qualifying event occurs, the duration of the
continuation period will be measured from the date of the initial
qualifying event. The COBRA continuation period will run
concurrently with any state-mandated continuation laws.
The Tax Equity and Fiscal Responsibility Act (TEFRA) requires
employers** to offer any working employees age 65 and over the same
medical insurance benefits available to employees under age 65. The
employee must be given the opportunity to elect either the Allied
group health plan or Medicare as their health benefit payor. Allied
cannot be the secondary payor to Medicare for TEFRA employers. If
you choose Allied as your primary plan, you will be eligible to
receive claim reimbursement from Medicare as a secondary payor for
eligible Medicare benefits for those eligible
charges that were not paid by the Allied plan.
Please contact Allied for the proper age 65 and over rates and
guidelines.
*COBRA applies only to employers who have employed 20 or more
employees on at least 50% of the working days in the previous year.
**TEFRA applies only to employers who have employed 20 or more
employees on at least 50% of the working days for the proceeding 26
weeks for the period you are in.
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Pre-Notification
>
What is Pre-Notification?
Pre-Notification allows us to assist the insured person and his or
her family with medical education material, high-risk monitoring
programs, and coordination of treatment plans and costs with doctors
and hospitals. These services help ease a patient through the
medical process and control expenses to the benefit of all insureds.
>
How do my employees provide Pre-Notification
to Allied?
Call Allied at (866) 317-5273.
> When should my employees call for
Pre-Notification?
• Within 30 days from the date of a pregnancy diagnosis.
• At least seven days before an outpatient surgery exceeding $1,000.
• Inpatient admission and treatment, before those services are used.
• Human organ or tissue transplants.
A medical review specialist will obtain all pertinent details
concerning the proposed medical treatments.
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PPO
Networks
>
How does my PPO network work?
Insured employees who utilize a PPO network have their pick of
doctors and hospitals within the chosen network and can save a
significant amount each year through lower medical bills and higher
benefits.
For additional information on specific facilities and physicians in
your PPO network please call the PPO network number on your ID card.
You can also access a link to your PPO network by visiting our
Find A Provider page.
Always confirm with your medical provider that they are part of your
PPO network before seeking treatment. Participating providers change
frequently and the inclusion of your provider on the list does
guarantee their current participation.
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Claim Filing
>
When should my employees file a claim?
A claim should be filed when an insured employee or dependent incurs
medical expenses that are eligible for coverage.
>
How do my employees file a claim?
Medical and Dental Claims:
The original fully itemized bill from the medical provider must be
sent to the address shown on the insured’s ID card. In most cases
claims are sent to your PPO network for repricing to provide you
with contracted discounts for your medical care. Most medical
providers submit claims directly as a courtesy to the patient.
Encourage your employees to give a copy of their insurance card to
their medical providers. Unless the ID card indicates that claims
should be submitted directly to Allied, any claims received by
Allied will be denied for improper submission and no benefits will
be paid.
Prescription Claims:
If your plan includes a drug card benefit, there is no need to
submit a prescription claim when using a participating pharmacy.
Otherwise, fill out the
Rx Reimbursement Form and submit the
claim form and the original prescription receipts to the address
shown on the claim form. These forms are included in the employees
Insurance ID card kit.
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ID Cards
> How do I order a replacement
ID card(s)?
To receive a new member ID card(s), please email
uas@alliednational.com.
Responding
Online
> Can I respond online to the letter
I received in the mail?
You can respond electronically to
your letter, by emailing
uas@alliednational.com.
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