We are committed to providing you with the information you need to successfully administer your employees’ benefits quickly and easily. Please don’t hesitate to contact us for assistance with any questions you might have. Call 800-371-9622 at Extension 2793 or email.
We’ve provided access to some commonly used forms for your employees. If you aren’t sure which ones your employees should use or don’t see the form they are looking for, please contact our Claim Department at (800) 371-9622.
When your employees have medical claims, keeping track of all of their bills and insurance payments can be overwhelming. To help them easily track their claims, we provide 24-hour online access to claim history. They can review all of their claims that have been filed under their Pekin Insurance Medical or Dental Plan any time day or night through an easy-to-use online claim history tracking program called WEBeci.
WEBeci allows your employees to review their claim history online, check the real-time status of the claim, as well as view EOBs (Explanation of Benefits) for claims once they are processed.
Feel free to contact the Health Claim Department with any questions you may have at 800-371-9622 or email.
*Pekin Life Insurance Company has contracted with Eldorado Computing, Inc., to provide WEBeci access.
To request a new ID card, click on the link below.
Making sure your employees are choosing the correct In-Network Provider will help them get the highest level of benefits under your plan.
Click on the Find a Provider button below to view the different networks we offer. Not all networks are available in all areas. Be certain to reference your master policy to determine your correct network. Only the network you chose can be accessed at the In-Network rate. If you are unsure of your network, please call us to confirm your group’s network at 800-371-9622, Extension 2793. Failure to use the correct network will greatly reduce your employees’ benefits.
Focus your valuable time and attention on your business, and let us provide you with the protection and peace of mind that come with Pekin Life Insurance Company administering COBRA for your employees.
Follow the link to learn the benefits of Pekin Life Insurance Company’s
Cold & Flu Prevention
http://www.pekininsurance.com/wp-content/uploads/2011/10/ColdAndFluPrevention.pdf
How to Quit Smoking
http://www.cdc.gov/tobacco/quit_smoking/how_to_quit/index.htm
Youth Tobacco Prevention
http://www.cdc.gov/tobacco/youth/index.htm
Alcohol Abuse and Alcoholism FAQs
http://www.niaaa.nih.gov/FAQs/General-English/Pages/default.aspx
Parents Prevent Childhood Alcohol Use
http://pubs.niaaa.nih.gov/publications/adolescent/adolflyer.htm
Guide to Healthy Living
Grandfathered Health Plans
Updated 11/18/2010
Under the Patient Protection and Affordable Care Act (PPACA), provision was made to allow people already covered by health insurance to keep that coverage. The term “grandfathered plan” was created to describe those plans that were in existence on March 23, 2010. Grandfathered plans are exempt from much of the new insurance reforms of the PPACA, as long as they retain their grandfathered status.
What PPACA Requirements Apply to a Grandfathered Plan?
For our grandfathered group plans, effective January 1, 2011, the following changes apply:
- A child of the insured who is not eligible for employer-sponsored health benefits on his or her own can be covered under the parent’s coverage to age 26, even if married.
- Lifetime benefit limits on essential health benefits are prohibited.
- Rescission of coverage is prohibited except in the case of fraud or intentional misrepresentation of material fact.
- Preexisting condition exclusions cannot be applied to persons under the age of 19.
- Annual limits on the dollar value of essential health benefits are restricted.
- An internal and external appeals procedure must be provided.
What Changes Cause a Plan to lose Grandfathered Plan Status?
Examples of changes that will cause a plan to lose grandfathered status are:
- Increasing an employee’s premium contribution rate by more than 5%.
- Eliminating benefits for a particular condition.
- Increasing an insured’s coinsurance percentage by any amount.
- Increasing a fixed deductible amount or an out of pocket limit by more than the rate of medical inflation plus 15%.
- Increasing a fixed amount copayment by more than the lesser of $5 plus medical inflation or medical inflation plus 15%.
- Eliminating a plan option.
What Benefit Changes Will Not Cause a Plan to Lose Grandfathered Plan Status?
- Adjusting plan eligibility rules.
- Conducting dependent eligibility audits to ensure only eligible dependents are covered by the plan.
- Adding employees and dependents to the plan.
- Making changes to comply with state and federal law.
- Voluntarily changing benefits to comply with health reform.
- Adding benefits.
- Making changes to dental & vision programs.
- Making changes to the PPO networks.
- Changing insurance carriers, so long as the structure of the coverage doesn’t violate one of the other rules for maintaining grandfathered plan status (amended 11/17/2010).
Non-Grandfathered Health Plans
Under the Patient Protection and Affordable Care Act (PPACA), a “non-grandfathered plan” is a plan that came into existence on or after March 23, 2010, or a previously grandfathered plan that made changes that were significant enough to cause it to lose its grandfathered status. Non-grandfathered plans are subject to all of the new insurance reforms of the PPACA.
What PPACA Requirements Apply to a Non-Grandfathered Plan?
As of September 23, 2010, new non-grandfathered plans must:
- Allow a child of the insured to be covered under the parent’s coverage to age 26, even if married.
- Provide unlimited lifetime benefits for essential health benefits.
- Only allow rescission of coverage in the case of fraud or intentional misrepresentation of material fact.
- Remove preexisting condition exclusions for persons under the age of 19.
- Provide essential health benefits.
“CHIP” Health Benefit Eligibility Notice for All Employees
An employer providing benefits in a state that offers premium assistance is required to provide the Employer CHIP Notice annually to all employees. Due to the fact that more than 40 states offer such a program, most employers will likely find it easier to simply send the model CHIP notice to all employees, rather than to try to send separate notices to employees based on the particular state in which the employees reside. An Employer CHIP Notice must be provided to each employee, not just the employees enrolled in the health plan of the employer.
The notice informs employees of potential state financial assistance to help pay for employer health insurance premiums. It explains that many states offer premium assistance to employees who are covered on their employer plan but are unable to afford the premiums. Many states use funds from their Children’s Health Insurance Program (CHIP) to assist people eligible for group health insurance but unable to afford their premiums. The notice includes information on how an employee may contact the state in which they reside for additional information regarding potential opportunities for premium assistance, including how to apply for such assistance.
If you have additional questions or would like a paper copy of the notice, please feel free to contact Group Policyholder Service at 800-322-0160, Extension 2814. We are at your service.
Group Coverage Continuation
State Continuation Forms
Wisconsin Continuation Notice (Form LG163-WIS)
COBRA Continuation Forms
COBRA Election Form (Form LG178)
Other Continuation Forms
Dependent Child Request for Continuation (Form LG271)
Spouse Dependent Request for Continuation (Form LG272)
If you have questions regarding a specific situation, please contact Group Policyholder Service at 800-322-0160, Extension 2814, for assistance.
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