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Small business service tips

Adding or losing employees

Find out how the Affordable Care Act (ACA) affects group size.

Call your account manager or our Small Business Services Customer Connection Team at 800-790-4661, option 3 at least 90 days before your group’s anniversary date to avoid delays.

Billing clarification

1. My client completed the Electronic Transfer for Initial Payment form to set up automatic payments. Why aren’t payments being automatically deducted from her bank account each month?

The Electronic Transfer for Initial Payment form (PDF) only authorizes us to withdraw the first month’s premium from a bank account. To set up automatic payments from the second month onward, your client needs to complete an Online Account Services User ID Request Form (PDF) and submit it by 1 of the 3 following ways:

  • By mail: 3840 Murphy Canyon Rd. San Diego, CA 92123
  • Email: CSC.SD.SBA@kp.org
  • Fax: 858-614-3345

Then the client’s group administrator will be able to set up auto payments through online account services.


2. How can my clients see their bills online?

Your small group clients can view and pay their bills online through online account services.


3. Is there is a quick way for me to see my clients’ bills?

You can save time by reviewing your clients’ bills online. Just log in to open your book of business on this website.

You can also use this handy guide (PDF) on the Already selling Kaiser Permanente page of the Working with KP, Administrative support section of account.kp.org to help you navigate to your book of business and your clients’ bills.


4. How many past statements can my clients see online?

You and your clients can now see 2 years’ worth of statements in PDF file format through online account services.


5. My client recently made a change to her account. How come the changes aren’t reflected in her statement?

It can take up to 2 billing cycles for changes to appear on statements.

If your client has already received the bill for the month her changes went into effect, tell her not to worry - just pay it as is. Adjustments for her changes and what she has already paid will appear in the “Retroactive Dues and Charges” section on her next statement. She may also view her change online through online account services.

If you have any other questions not covered here, please call our California Service Center at 800-790-4661, option 1.

6. If my client has a consolidated bill and she adds or drops a plan, how long will it take to reconsolidate the changes into a single bill?

If your client currently has a consolidated bill and she adds or drops a plan, it can take 2 to 3 months to reconsolidate the changes into a single bill. In the meantime, she’ll get separate bills for each plan.

Broker of record changes

A broker of record (BOR) is the broker authorized to represent a client’s decisions on health plan coverage. As a BOR, you may receive copies of the communications we send to your clients, including quotes, notifications, and policy information. The BOR can receive compensation from Kaiser Permanente and designate additional payee brokers.

From time to time, one of your clients may wish to add, change, or remove a BOR. Here are some frequently asked questions regarding that process — and also, helpful tips for serving them.


1. Who is authorized to make a broker of record (BOR) change?

A BOR change request can be made only through a letter signed by the contract signer or an interested party authorized to make contract changes at your client’s company.
Note: When adding an Interested Party using the Contact Change form, be sure your client checks the box that authorizes the interested party to make changes on behalf of the client. Otherwise, the interested party will not have authority to make any changes, such as adding a broker of record (BOR).

  • The contract signer is the person responsible for signing the group agreement. He or she is the main person authorized to make membership or contract changes to your client’s account.
  • An interested party can be any person authorized to access information about the group, such as enrollees, premium contributions, and plan selections. An interested party may also be authorized to make contract changes to the contract, such as adding or deleting employees, adding or deleting plans, increasing or decreasing premium contributions.

Important: If the BOR change request letter hasn’t been signed by the contract signer or an interested party authorized to make changes to the contract, we’ll return it to your client for correction. This will delay the process until a new request letter with an authorized signature is received.


2. How does a client add, change, or remove a BOR?

To add, change, or remove a BOR, tell your client to:

  • Submit a BOR change request on client letterhead.
  • Make sure the request is signed by an authorized representative of the client, and include his or her printed name and title.
  • Include your broker identification number and your name as the agent of record.
  • Include the effective date of the BOR change. Future-dated requests are acceptable, but we can’t honor backdated requests. Requests dated after the first of the month will have an effective date for the following month at the earliest.
  • Send the request to our Small Business Customer Connection Team — preferably by email to amt@kp.org. You can also fax it to 800-369-8010.


3. How long does it take to process a BOR change?

You can let your clients know it typically takes between 48 and 72 hours to process change requests.


4. A BOR change has taken more than 72 hours to process. What’s its status?

If a request isn’t in the system after three days or more, it’s typically because some of the required materials weren’t received or because the request was backdated. Talk to your account manager to see whether your client should resubmit the request.


5. When is the BOR change effective?

The effective date for your client’s BOR change depends on the date we receive their request. Complete paperwork must be received by the fifth business day of a month for the change to be effective on the first of that month. A BOR request letter (including all necessary information) received after the fifth business day of a month will be effective the following month.

For example, if a change request was properly submitted and received on December 3, 2014, it should have an effective date of December 1, 2014. However, if a change request was submitted December 3, 2014, but it was incomplete and updated information wasn’t received until December 10, 2014, then the change would have an effective date of January 1, 2015.


6. Why is a previous broker still appearing on correspondence?

This could be a timing issue — for example, if we hadn’t yet processed the BOR change at the time of a renewal. It could also be because:

  • we didn’t receive the BOR request
  • it was incomplete
  • it hasn’t been forwarded to the proper department yet

You should always keep proof of delivery, either email or fax confirmation, to show the date Kaiser Permanente received the request letter since this can affect the effective date.


7. Why am I no longer the BOR for a particular group?

This is typically because a BOR change was processed at the group’s request. We’ll send out a courtesy letter when we process a BOR request, but if there are delays in processing the request, that notice will also be delayed. And please remind your clients that it’s their responsibility to inform a broker if he or she has been replaced. If you think a BOR change was made in error, please contact your account manager.


8. Why wasn’t I notified of a BOR change?

A notification letter is typically sent on the day any BOR change is processed. For future-dated small business BOR changes, a letter is typically sent within one week of the processing date. If you didn’t receive a letter, please contact your account manager.


9. I’m part of a firm that has purchased (or been purchased by) another firm. How do mergers, acquisitions, and book of business transfers affect the BOR?

For questions about mergers and acquisitions, contact Broker Compensation Services at 800-440-2323. They need a letter that:

  • explicitly notifies us of the sale
  • tells us which groups are to be moved to the new owner
  • includes the effective date
  • is signed by the selling and buying brokers

Please note that we cannot always accommodate requested effective dates. If a group has paid its premiums in advance and the selling broker has already received commission, the effective date will be the first day of the coverage period that hasn’t yet generated a commission payment for that group — meaning different groups in the same book of business might have different effective dates based on their commission payment activity.


10. When does a BOR change show up online?

Once a change has been processed, it should show up online right away. If the BOR change was completed for a future effective date, the change shouldn’t show up online until that date.


11. What if a group isn’t commissionable?

There are situations in which brokered groups might not be commissionable. If you’d like to make a particular group commissionable, contact your account manager to set up a conversation with a sales executive.


12. Can I split commissions on a particular group with another broker?

Yes, splits can be established on a BOR request, or in a letter from the current broker. Please email your request on your company letterhead to amt@kp.org. Make sure it’s signed by the authorized representative of the group. Include the printed name alongside the signature.


13. Why am I not being paid commissions on a BOR change I submitted weeks or months ago?

If you aren’t receiving commissions on a BOR change, it may be because the paperwork:

  • is in the system but hasn’t been processed yet
  • isn’t in the system or is incomplete

Your account manager can tell you whether the paperwork is still processing or whether you need to resubmit all or part of it. If you need to resend information, it may help to request confirmation of receipt via fax or email.

If you have any other questions not covered here, please contact your account manager.


14. How do I submit a "Broker of Record" change request letter?

For us to make sure your Broker of Record letter gets processed in a timely manner you should:

  • Make sure the Broker of Record change request is on the employer groups company's letter signed by an authorized signature (include printed name and title in addition to the signature).
  • Make sure letter includes your Broker Identification number (aka BID) and your name as the agent of record.
  • Again, ensure that the request is signed by an authorized contact of the company.
  • Submit letter before the 5th business day of the month for the change to be effective the 1st of the current month. The cut-off date is based on the receive date and not the letter date. However, the letter must be dated on the 1st day of the current month or before and received (and deemed complete) on the 5th or before to get 1st of current month effective date.
  • Send the letter to the Customer Connection Team via fax or email (preferred):
    • Small Business Services Customer Connection Team Fax: 1.800.369.8010
    • Small Business Services Customer Connection Team Email: amt@kp.org
  • Please allow up to 48 hours to process; 72 hours during peak to receive an acknowledgement of receipt.

  • Note: When the entity responding to your email will be coming from AMT, not a person's name. The response emails may be found in the recipient's spam folder. Make sure to check that folder, too when waiting for a response.

Cal-COBRA information for employees who lose coverage

When your clients’ employees are no longer covered, it’s easy to have Cal-COBRA packets sent directly to them. Just write “Please send Cal-COBRA packets” at the top of the Subscriber Termination and Transfer form. Be sure to confirm the correct member mailing address is on file with us prior to submitting the form.

California Service Center email best practices

To make sure your request is processed efficiently, follow these guidelines when you email a request to our Small Business Services California Service Center1.

Include a clear subject line

The subject line should include your client’s:

  • Company name
  • Purchaser identification (PID) number 
  • Request

Subject line example:

ABC company-123456-subscriber termination request

Use recommended attachment formats

Use these file formats for attachments: .doc, .docx, .xls, .xlsx, .pdf, .bmp, .txt, .tif, .tiff, .jpg, .jpeg.

Don’t use: .gif, .mpg, .rar, .avi, .wmv.

Don’t include important information in body of email

Only the attachments included in your emails will be processed. Any requests made in the body of an email won’t be addressed.

Don't send password-protected attachments

They can't be opened or processed.

Email the right team

Remember to submit enrollment applications, account change forms, and member terminations2 to our California Service Center.

For other types of requests, go to our contact us page or download our quick reference guide (PDF).

1 The California Service Center’s e-mail box is unmonitored. It cannot reply to questions and can only accept forms. If you would like to include specific instructions or notes with the application, be sure to include them as an attachment and not in the body of the e-mail.

2 Terminations must be received in the month of the subscriber or group termination.

COBRA reporting

Under the federal Consolidated Omnibus Budget Reconciliation Act (COBRA), employees and their families can continue to get group health coverage for a period of time after the employee no longer works for the company. Your client’s employees and their families may qualify for COBRA coverage in these situations:

  • Voluntary or involuntary job loss
  • Reduction in hours worked
  • Divorce from the covered employee
  • Death of the covered employee

For more information on COBRA, please see the “COBRA regulations” section of the “Government guidelines” page.

1. How do my clients know who’s enrolled in COBRA?

Only clients with active COBRA members, will receive a Billed Federal COBRA Activity Report from Kaiser Permanente listing current COBRA members for that month.

The report also lists former employees who:

  • have missed COBRA payments
  • are being terminated from COBRA, either for nonpayment, or because they’ve reached the maximum period of COBRA continuation coverage

2. Who receives my clients’ COBRA activity report?

The person at a company who’s been specified as the contract signer will automatically receive the report.

3. What if my clients want someone other than the contract signer to receive the report?

To have the activity report sent to someone else at a company, ask your client to contact our Small Business Services Customer Connection Team at 1-800-790-4661, option 3.

4. Who can answer questions about the COBRA activity report?

Contact our California Service Center at 1-800-790-4661, option 1.

Contract changes

1. Make sure your clients complete the right forms

If a group’s contract signer has left the company or changed positions, your client needs to:

2. Make sure forms are completed and signed by an authorized signer

If your client submits a Contact Change Request form or Online Account Services User ID Request Form, make sure:

  • the form is completed and signed by an authorized signer
  • the authorized signer prints their name and title

We won’t accept any form not signed by an authorized signer.

The types of account changes that require an authorized signature are:

  • address changes
  • anniversary date changes
  • broker of record changes
  • contract changes
  • plan changes
  • reinstatement of contracts
  • renewal changes
  • terminations

3. Who’s authorized to sign the forms?

There can only be one authorized contract signer for an organization. That person is:

  • responsible for signing the Group Agreement
  • responsible for renewal information
  • the principal person authorized to make membership or contractual changes to the account

Enrollment and plan change forms


1. When should my clients submit an Employee Enrollment form?

They only need to submit an Employee Enrollment form (PDF) when they’re adding an employee as a new Kaiser Permanente member. For changes of status (like adding new dependents), they can submit an Employee/Dependent Change form (PDF).


2. My client’s employee needs to add a new dependent to their Kaiser Permanente plan. Do they need to submit an Employee Enrollment form?

No. They can just submit an Employee/Dependent Change form (PDF) to add the new dependent.


3. Do my clients need to submit a new Employee Enrollment form for employees who are staying enrolled as Kaiser Permanente members this year?

No. If their employees are currently Kaiser Permanente members, they don’t need to submit any paperwork unless they’re making changes to their plans.


4. How do clients submit completed forms?

Your clients can fax forms to 858-614-3344 (Northern California) or 858-614-3345 (Southern California), or email them to CSC.SD.SBA@kp.org.


5. Is there anything else my clients need to remember?

To avoid processing delays, remind your clients that their employees must print and sign their names in the signature field below the “Kaiser Foundation Health Plan, Inc., Arbitration Agreement” section of the “Employee Enrollment Form”.

If you have any other questions not covered here, please contact your account manager or call our Small Business Services Customer Connection Team at 800-790-4661, option 3.

Making health plan changes at renewal

1. When your clients make health plan changes at renewal, remind them to double-check their paperwork.

  • They must complete, sign, and fax all pages of the Renewal Changes form to 800-369-8010 or send by email to amt@kp.org. If they make changes to Section 1 and/or Section 2, they must include Section 9 (Census).
  • They must verify health plan changes or additions for each current and new employee by reviewing all their paperwork. Section 9 of the Renewal Changes form.
  • If your clients aren’t making any changes, there’s no need to submit the Renewal Changes form.

2. Remind your clients to submit changes before their renewal date.

  • To ensure all updates are in place for your clients and their employees by their effective date, make sure changes are submitted by the 1st of their renewal effective month.
  • Health plan changes received by 5 p.m. Pacific time (PT) on the 15th of the month will be applied retroactively to the 1st of their renewal month. Changes received after 5 p.m. PT on the 15th of the month will be effective the 1st of the following month.

Your clients will receive a health plan change acknowledgment letter when the request is approved.

Please note: If your clients leave a grandfathered (nonmetal) health plan, they won’t be able to go back to it.

Member age used in calculated rates

Will my clients’ rates change if they have a birthday before it’s time for the next renewal?  

Rates for subscribers and dependents are calculated based on their age at the start date of the last contract period (the renewal date). This means that a client’s rates won’t change if he or she has a birthday before it’s time for the next renewal. This applies to subscribers and dependents who are enrolled from the contract start date and those added to the contract period midyear.

Multiple plan options

1. Remind your clients of the basic rules of offering multiple plans

Depending on how many subscribers they have, your small groups may offer a different number of Kaiser Permanente plans to their employees:

  • Groups with fewer than five enrolled subscribers can offer a choice of up to three Kaiser Permanente plans.
  • Groups with six or more enrolled subscribers can offer as many Kaiser Permanente plans as they like.

If a group with fewer than five subscribers selects four or more plans, they’ll get a letter asking them to add another subscriber or reduce the number of plan selections — which will cause processing delays

2. Make sure your clients complete and submit the right paperwork

There are two ways for small groups to submit plan changes:

1) Changes can be made during their annual renewal using the Renewal Changes form located in their renewal package, or

2) they can make midyear plan changes using the Plan/Add Change Request form (PDF) available online.

Either way, the most important information is the plan(s) your client wants to add or cancel — which is covered in section 2 of the Renewal Changes form and section 3 of the Plan/Add Change Request form, respectively.

You also need to confirm that they list any plan changes or additions for every current and new employee. This is covered in section 9 of the Renewal Changes form and section 4 of the Plan Add/Change Request form. Please check that the plan names listed in these sections are currently available.

Finally, remind your clients to fully complete, sign, and fax back the materials.

3. Encourage your clients to submit all their plan changes at the same time

When your clients make plan changes, ask them to submit all fully completed forms at once. Any missing information or subsequent changes will result in processing delays.

Separating 1 regional contract into 2

If your clients’ small business has locations in Northern and Southern California, and the non-headquarters region has at least 13 Kaiser Permanente subscribers, the group may need to separate its contract. This will give each location its own contract and customer identification number (CID).

To help make this transition easier, we’ve simplified our process:

  • Groups only need to separate at their renewal — not midyear.
  • We no longer require all separating groups to submit a New Group Application.
    • Only groups that offer Kaiser Permanente Insurance Company (KPIC) plans (PPO) need to sign and submit a prepopulated New Group Application. For these groups, your Account Manager or a Small Business Services Customer Service Connection Team representative will reach out to help you with the process.
    • If a group doesn’t offer a PPO plan, no action is needed. Kaiser Permanente will separate and renew the group. Any members affected by the separation will get a new ID card.

What if my clients’ group uses Electronic Data Interchange (EDI) to send files?

After separating their group, they must update their EDI file with the employees from each region. We recommend making updates by the end of their renewal month.

What if my clients’ group uses online account services?

The group with the original contract will need to add the new location on online account services by filling out our Online Account Services User ID Request Form (PDF). Be sure to include the CID of the group with the original contract and the new CID of the other region. After making the updates, they’ll be able to access both regions from one account.

How many bills will my clients get?

Your clients’ group may receive a bill for each contract. Billing may take 1 to 2 months to catch up after the separation. Until that happens, they may see a credit or retro charges on their bills. We recommend they pay as billed.

If my client offers one or more grandfathered plans, will the risk adjustment factor stay the same after the separation?

Yes, the grandfathered risk adjustment factor stays the same for both groups if your clients offer one or more grandfathered plans.

Do my clients’ employees’ deductible and out-of-pocket accumulations follow them if they’re moving to the new location?

Yes. After the member is transferred, we’ll transfer all deductible and out-of-pocket accumulations. This process can take 30 days or more to complete after the group’s renewal date.

Why do affected members receive a Certificate of Creditable Coverage letter?

We are required to send this letter when any member is terminated from a group. Affected members who are terminated from the contract for the headquartered location will receive a Certificate of Creditable Coverage letter. Members affected by the separation can disregard the letter because they were immediately enrolled in the new group located in the opposite region.

How long does it take to separate a group?

It takes about 4 weeks, not including the time it takes to transfer any deductible or out-of-pocket accumulations.

What if I have more questions?

Please contact your account manager or our Small Business Services Customer Connection Team at 800-790-4661, option 3.

Submitting enrollment forms

1. Make sure the plan listed on the Kaiser Permanente enrollment form matches your client’s plan offerings:

Before submitting the Kaiser Permanente Employee Enrollment form, double-check that your client has selected the correct plan. If a plan needs to be added or changed, they must submit a Plan Add/Change Request form (PDF).*


2. Make sure section A of the Kaiser Permanente Employee Enrollment form is complete and correct:

The section that says “To be completed by employer” (section A) must be completed by the group or your office. It should include:

  • the legal name of the business (Kaiser Permanente contract group name)
  • customer ID
  • valid enrollment reason

Fictitious names (for example, “Doing Business As”) or other names that aren’t in our records won’t be accepted.


3. Make sure your clients’ employees verify the information on their Kaiser Permanente ID cards:

Spelling errors and incorrect information on their cards could delay service. They should verify:

  • member name
  • date of birth
  • medical record number
  • gender

4. If dependents live at a different address or in another Kaiser Permanente region, make sure they have adequate coverage under the group’s policy before processing the form:

In some cases, they may only have emergency or urgent care coverage.


5. If your clients are located outside the Kaiser Permanente service area, make sure their employees use their home addresses, not their employer’s address:

Only employees in our service area based on their home ZIP code will be eligible for coverage.#

Terminating a small group contract

How do I help a small group terminate their contract with Kaiser Permanente?

 1. Contact a Kaiser Permanente representative.

  • If you have an assigned account manager, call to see if they can help you retain the group. If your client still wants to end their coverage, continue to step 2.
  • If you don’t have an assigned account manager, call our Small Business Customer Connection Team at 800-790-4661, option 3, Monday through Friday, 8:30 a.m. to 5 p.m. Pacific time.
  1. 2. If your client still wants to end their contract, ask for a Group Termination Request form. Your Kaiser Permanente representative will help you complete the form over the phone, then email you the form so you can forward it to your client's authorized contract signer for a wet signature. Contract termination requests on a company's letterhead aren't accepted.
  2. 3. When you receive the signed Group Termination Request form from your client, email it to amt@kp.org or fax it to the Small Business Customer Connection Team at 800-369-8010.

Who's responsible for stopping autopay?

If your client pays their premium through autopay, it's their responsibility to turn it off once all premium owed has been paid. If you or your clients have questions on how to stop autopay, please call the California Service Center at 800-790-4661, option 1.

Can my client request reinstatement of their contract later?

Yes, your client can request reinstatement of their contract within 60 days of their termination date without lapse in coverage and without needing to go back through the underwriting process.

Can I use a Declination of Coverage form to request termination of a small group contract?

No. The Declination of Coverage form is for employees who want to decline group health coverage with Kaiser Permanente.

Understanding when we send new member ID cards

Your clients’ employees will get new ID cards when they:

  • Become new Kaiser Permanente members.
  • Switch to a plan that uses another type of card (for example, from small business coverage to Medicare coverage).
  • Have a gap in coverage that’s 396 days or more.
  • Lose their card and ask for a replacement through Member Services1.

Understanding when we don’t send new member ID cards

Your clients’ employees won’t get new ID cards when they:

  • Switch to a plan that uses the same type of card (for example, from an HMO plan to a deductible HMO plan).
  • Have a gap in coverage that’s 395 days or less.
  • Renew their Kaiser Permanente plan every year2.

1 Most members can also access their digital ID card through kp.org or the Kaiser Permanente app. This option is not available for Northern California, Medicare members, and some out-of-area plans.

2 If your groups want a mass reissuance of ID cards for renewed members, they can obtain hem for a processing fee. Contact your account manager or call the Small Business Services Customer Connection Team at 800-790-4661, option 3.

Updating an email or physical address

Save time and reduce confusion by helping your small business clients understand the process to submit the right information when changing an email or physical address.

Changing an email address

To change an email address, your clients can contact our Small Business Services Customer Connection Team in one of the following ways:

  • Call us at 800-790-4661, option 3.
  • Have an authorized signer for the group send an email to amt@kp.org with the subject line “Email address change request.” Be sure that the body of the email includes your client’s Customer ID number, first name, last name, and new email address.

Changing a physical address

If your client would like to change a physical address, they’ll need to have an authorized signer for the group contact our Customer Connection Team by email or fax.

By email

Send an email to amt@kp.org with the subject line "Physical address change request." Be sure that the body of the email includes your client's Customer ID number. For each address that needs to be changed, please let us know if the address we're updating is a:

  • Physical location (California address — no P.O. boxes or purchased addresses)
  • Billing address (where we’ll mail billing statements)
  • Mailing address (where we’ll mail contract and renewal information)
  • Physical, billing, and mailing address (if they’re all are the same)

By fax

Complete a Customer Address or Name Change Request form (PDF) and fax it to our Customer Connection Team at 800-369-8010.

Please fax separate forms for each address that needs to be changed.

For more information

If you have any other questions, please contact your account manager or call our Small Business Services Customer Connection Team at 800-790-4661, option 3.

Use HTML format when you email Small Business Services

To avoid delays in processing your requests, please use the HTML message format when sending emails to Small Business Services. Messages sent in other formats may be distorted by our email system, so please check your settings.

For example, if you use Outlook, here’s how to check or change your message settings:

  1. Click the “File” tab.
  2. Click “Options.”
  3. Click “Mail.”
  4. In the “Compose in this message format” list, click “HTML.”
  5. Click “OK.”

* Groups that renewed in 2016 and wish to add or discontinue plans should use the 2016 version to request a midyear plan change prior to their next renewal. Groups that have a 2015 contract (or that haven’t renewed in 2016) should use the 2015 version to request a midyear plan change prior to their next renewal.

# For more details, please see page 13 of the Small Group Administrative Handbook (PDF).

 
 
 
 
 
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