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Health Insurance FAQ

Q: What types of medical options are provided through PremierHealth?
A: PremierHealth includes Open Access Plus (OAP), a preferred provider network, and provides comprehensive Indemnity medical coverage where the OAP networks are not available.

Eligibility

Q: Which employees are eligible for PremierHealth enrollment?
A: To be eligible for PremierHealth insurance coverage, employees must be premium-paying members of Benefits for Life or have a $50 monthly minimum contribution made on their behalf to the Tax-Deferred Annuity (TDA).

Q: How does an employee qualify for dental coverage?
A: Employees must enroll in the PremierHealth medical plan in order to be eligible for dental coverage. If dental coverage is not selected when an employee first enrolls in PremierHealth, dental coverage will not be available for two calendar years. If dental coverage is elected, the employee must keep dental coverage for two calendar years before the coverage can be dropped.

Enrollment

To enroll in PremierHealth, an employee must first enroll in MMBB’s Benefits for Life program or TDA.

Q: When is enrollment permitted?
A: Enrollment is possible within 30 days of one of the following qualifying events:

  • Date of enrollment for the first time in either Benefits for Life or TDA;
  • Date of hire with an eligible employer if the employee is already enrolled in Benefits for Life or TDA; or
  • Date that prior health insurance ends due to the following involuntary circumstances:
    • Employment termination;
    • Divorce;
    • Death; or
    • Employer cancellation of employee medical coverage.

Spouses can be added to the PremierHealth enrollee’s coverage if the spouse loses health insurance due to employment termination or the employer cancels medical coverage.

Eligible employees who are not enrolled in PremierHealth have an opportunity to enroll during the “open enrollment” period. The open enrollment period is announced to members every fall, for coverage effective January 1 of the following year.

Q: How do employees enroll in PremierHealth?
A: Request an enrollment package and the amount of the monthly premium from UMR by calling their toll-free number: 866.868.0502, option 1. After the employee completes the application, you, the employer, then send it to UMR with a check for the initial month’s premium.

Q: Where are payments for PremierHealth sent?
A: The initial monthly premium payment that must be submitted with the application is sent to: PremierHealth, P.O. Box 690188, San Antonio, TX 78269. Ongoing premium payments should be sent to the PremierHealth lockbox at: PremierHealth Premium Account, 75 Remittance Drive, Suite 1412, Chicago, IL 60675-1412.

Q: What levels of coverage are available?
A: PremierHealth offers coverage for members only; members and spouses; members and children; and families (member, spouse and children).

Q: Who qualifies as a dependent?
A: Dependents include the employee’s spouse and children.

Q: How long can children be covered under the enrollee’s coverage?
A: Generally, children of enrolled members may be covered until they become 26 years of age.

Q: Can PremierHealth coverage continue if the employee’s employment terminates or the dependent child reaches the age limit?
A: MMBB allows for Continuation of Coverage of up to 18 months for an enrollee who is no longer eligible for coverage based on his or her employment status or a dependent child based on the dependent’s age. Continuation of Coverage premium rates are 102% of premium rates in effect while the employee had an eligible employer. Individuals must enroll in Continuation of Coverage within 60 days of the qualifying event. Premiums are paid by the person who is insured.

Q: When does PremierHealth coverage become effective?
A: Coverage becomes effective on:

  • January 1 following the annual open enrollment period;
  • The first of the month following either the initial enrollment or eligible change in enrollment; or
  • The first of the month following the loss of previous health insurance coverage.

Q: How can the employer speed up the enrollment process?
A: Consider the following:

  • Have application forms from MMBB and UMR in hand before hiring new employees.
  • Have new employees complete all applications before employment begins.
  • Contact MMBB for the initial month’s Benefits for Life or TDA premium amount.
  • Contact UMR for the monthly PremierHealth premium amount.
  • Send MMBB application forms and appropriate checks via overnight mail to MMBB. UMR application forms and checks should be sent via overnight mail to UMR’s overnight mail address: UMR/PremierHealth, 12668 Silicon Drive, San Antonio, TX 78249.

Q: Do pre-existing conditions apply for new enrollees?
A: If the enrollee was previously insured in a health plan for at least 12 months and does not experience more than a 63-day lapse in coverage between the prior plan and PremierHealth, pre-existing condition limits would not apply. A Certificate of Creditable Coverage from the prior insurance company would need to be provided to CIGNA upon request. The Patient Protection and Affordable Care Act of 2010 prohibits pre-existing conditions exclusion for children under the age of 19.

Premium Rates

Q: How are PremierHealth premiums determined?
A: Premiums are based on the geographic location (residence zip code) and the age of the employee. The geographic rates fall in three bands: low, average or high cost.

Q: How can one learn what the premium rates are?
A: For premium rate tables, visit www.tpa.com/mmbb or call UMR, toll free, at 866.868.0502, option 1.

Q: When an employee moves from one age band to another, when does the premium increase take effect?
A: Premium increases begin with the month after which the employee’s birthday puts him or her in a higher premium rate bracket, unless the employee’s birthday is on the first of the month.

Billing

Q: When are premiums due?
A: Invoices are mailed at the beginning of the month before the month of coverage. Payments are due by the last business day of the month before the month of coverage. For example, invoices for October will be mailed the first business day of September and are due by the end of September.

Q: What happens if a payment is not received on time?
A: If the payment is not received by the due date, UMR will:

  • Send a reminder that if the outstanding premium is not received by the end of the month for which the premium is being billed, coverage will terminate. This notice will be mailed early in the month for which the premium payment is due.
  • Send a second notice in the middle of the month for which the premium payment is due, if payment is not received.
  • Send a termination notice to you as the employer, as well as to the employee, immediately following the month for which the payment is due.

Example: The invoice for October is not paid by the end of September. A first notice will be mailed at the beginning of October. If payment for October is not received by the middle of October, a second notice will be sent. If October’s invoice is not paid by the end of October, coverage will be terminated effective September 30 and a termination notice will be mailed at the beginning of November.

Changes in Coverage

Q: Who should be notified of changes such as birth of a child, marriage or divorce?
A: Contact UMR at 866.868.0502, option 1, to request a change form and contact MMBB at 800.986.6222.

Q: What if a PremierHealth enrollee reaches age 65 and becomes eligible for Medicare, continues working and does not start an MMBB annuity?
A: The enrollee and any family members enrolled would remain in the PremierHealth plan.

Q: What if our church intends to provide health insurance for our minister and budgets for it but the minister’s spouse has coverage through his or her employer?
A: Since the minister already has health insurance through his/her spouse, churches in this situation may wish to contribute the dollars set aside for health insurance to TDA for the minister. If the church provides the budgeted amount to the minister as cash, the payment will be considered taxable income.

Employment Changes

Q: When a member currently enrolled in PremierHealth leaves employment without giving information about a new eligible employer, how are premiums handled?
A: When you, as the employer, stop paying premiums, coverage for the member will be terminated. If the member wants to continue coverage, she or he must contact UMR and complete a Continuation of Coverage application. The application must be completed within 60 days of when the employer stops paying the premium. The member will be responsible for Continuation of Coverage premiums, and will be billed at 102% of the premium rate. If
the member does not complete and return the application within 60 days, the individual will not be eligible for PremierHealth until he or she satisfies one of the eligibility criteria described above.

Q: What if our church calls a pastor who has been enrolled in PremierHealth but his or her coverage was inactivated because UMR had not been notified of the member’s new employer?
A: You, as the new employer, can make up to two months of the required payments to reinstate the member’s coverage. For a longer gap in coverage, the member must wait until the fall open enrollment for coverage effective the following January 1.

Example: A PremierHealth enrollee’s coverage is terminated October 31 because the October premium is not paid by the end of October. In November, UMR is contacted by the enrollee’s new employer indicating it has agreed to pay the enrollee’s premiums. The employer will need to send the premium amount due for October and November no later than the end of November to reinstate coverage. Otherwise, the enrollee is not able to re-enroll until the fall open enrollment for coverage effective the following January 1.

Address Changes

Q: If a PremierHealth enrollee’s address changes, who should be notified?
A: Contact UMR directly with address changes for those covered by PremierHealth. The member or employer should also contact MMBB.

From the 2012 MMBB Guide for Church-Related Employers. For the full guide, please visit our Download Documents & Resources section.