1 - How many employer groups can Avenue H support?
No limits have been set at this time.
2 - When should an employer apply to join Avenue H?
The employer may join Avenue H any time of the year, and will not be penalized with an off-anniversary surcharge for coming into Avenue H at the time other than the regular annual renewal anniversary. However, the employer may receive a better rate offer by applying on-anniversary. The group's risk adjustment factor (RAF) or "rate-up" in the Exchange cannot be higher than the group's renewal RAF if the group applies on-anniversary, and if their current insurance is with an insurer who is participating on Avenue H. For example, if a group is covered on a small group plan outside Avenue H with an insurer who participates in Avenue H, and is offered a renewal at the 25% rate up, and if Avenue H new business underwriting process rates the group at the maxiumum (85%), Avenue H is obligated to offer the group the 25% rate up if they apply on-anniversary.
3 - Which employer groups are eligible to participate in the defined contribution system? What group size will Avenue H accommodate?
Beginning January 1, 2011 employers in Utah, with group size 2 to 50, are eligible to enroll in the defined contribution system.
4 - If a married couple both draw a W-2 wage from a small business, and the business has no other eligible employees, can the couple both apply as individuals to form the minimum group size of 2 in Avenue H.
No. The group would be ineligible until they have another adult applicant that is an eligible employee.
5 - If more than one member of an immediate family is an eligible employee under a group, do all eligible employees need to apply to Avenue H?
All eligible employees must apply with Avenue H and complete the employee health application unless they are waiving coverage, in which case the employee must login to Avenue H and complete the waiver.
6 - If an employer has a large number of out-of-state employees, can they join Avenue H to provide coverage for their Utah employees only?
Currently no more than 50% of enrolled participants can reside outside of Utah.
7 - When will Avenue H close employer registration?
Group registration never closes. However the time frame for enrollment and plan renewal dates will change based upon the benefit effective date requested for the group being submitted.
8 - How does the registration process work?
Producers may register a group for Avenue H via a secure online portal. Eligible employees will be required to complete an on-line Universal Health Insurance Application. Completed applications are submitted to participating carriers for underwriting and approval of the group. If group is accepted, the underwriting process continues; groups not meeting requirements will receive notification from Avenue H.
Paper applications cannot be accepted by Avenue H. Universal Health Insurance Applications are available for review from the Utah Insurance Department (Rule 590-247).
9 - What documentation must employers provide?
Employers must provide a Census File and a Quarterly Wage & Tax file. New employers who have not yet filed a Quarterly Wage & Tax file may provide:
- A copy of their business license along with a copy of their payroll.
OR - A copy of their Articles of Organization or Incorporation along with a copy of their payroll.
10 - Are there other employer responsibilities?
Employers must establish a pre-tax mechanism for employees to use pre-tax dollars to purchase a health benefit plan through Avenue H. This may include:
- A health reimbursement arrangement (HRA)
- A Section 125 Cafeteria plan OR
- Another plan or arrangement similar to mechanism 1 or 2 above which is excluded of deducted from gross income under the Internal Revenue Code. The employer is also responsible for choosing a default health benefit plan for the group and for notifying each employee that he (the employee) will be enrolled in the default plan and payroll deductions will be initiated for premium payments.
- The employee notifies the employer that he (the employee) has selected a different plan available through Avenue H
- The employee provides proof of other health benefit coverage
- The employee specifically declines coverage in a health benefit plan
- Finally, the employer may not offer a major medical health benefit plan that is not part of the defined contribution arrangements available inside Avenue H.
11 - Are there any group participation requirements?
At least 75% of the group's employees that are eligible for benefits must enroll in a health benefit during the group's open enrollment period for the group to participate on Avenue H. Employees with a valid waiver can be excluded from the participation check.
