egma Producer Manual 2018 Oregon & Clark County, Washington Version 1.3 Sales Operations Dove Ronai Updated: January 22, 2018

Transcription

1 egma Producer Manual 2018 Oregon & Clark County, Washington Version 1.3 Sales Operations Dove Ronai Updated: January 22, 2018 File Name: 2018 egma or_cc producer manual Page 1 of 37 Updated: January 22, 2018

2 Table of Contents Overview... 4 Starting an egma... 5 Starting a New egma Starting an egma from a Previously Prepared Quote... 5 Resuming Work on a Previously Saved egma... 6 Viewing Status of egmas... 6 List View... 6 Kanban View... 7 What these categories represent... 7 egma Tool Tabs... 8 Tabs... 8 Saving... 8 Help... 8 Landing Page... 8 Moving Throughout an egma... 8 Attachments... 9 Start Tab... 9 Start Tab - Button 1 Coverage Options... 9 Start Tab - Button 2 Coverage Options... 9 Start Tab - Button 3 Other Carrier Coverage Start Tab - Button 4 Current Coverage Start Tab - Button 5 Coverage for Enrolled Employees Start Tab Button 6 ACA Requirements Start Tab Button 7 Verification of Group Size Benefits Tab Benefits Tab - Button 1 Network Selection Benefits Tab - Button 2 Medical Benefit Selection Benefits Tab - Button 3 Additional Coverage Options Benefits Tab - Button 4 Medical Rate Structure Benefits Tab - Button 5 Dental Benefit Selection Contact Tab Contact Tab - Button 1 Group Contacts Note: You will need to scroll down the screen to see all the options available Contact Tab Button 2 Billing Preferences File Name: 2018 egma or_cc producer manual Page 2 of 37 Printed: January 22, 2018

3 Contact Tab - Button 3 Third-Party Administrator (TPA) Group Tab Group Tab - Button 1 Group Name Group Tab - Button 2 Physical and Mailing Addresses and Headquarters Group Tab - Button 3 Tax IDs Group Tab - Button 4 Business and Industry Group Tab - Button 5 Applicable Federal Mandates, Deductible, and Out of Pocket Accumulators.. 19 Group Tab - Button 6 Enrollment Preferences Group Tab - Button 7 Class, Probationary Period, and Contribution Group Tab - Button 8 Contribution Section Enrollment Tab Enrollment Tab - Button 1 Participation Requirements Producer Tab Producer Tab - Button Attachments Tab Attachments Previewing the egma Sharing the egma With Group for Signature Group s Review and Signing Declines to Sign Submitting an egma to Regence Printing and/or Saving a Copy of the egma Producer Center egma Statuses egma Producer Action Required Cancelling an egma File Name: 2018 egma or_cc producer manual Page 3 of 37 Printed: January 22, 2018

4 Overview This document contains the collective information about the egma Tool regardless of the audience. The egma Tool will allow us to get more complete information from our groups which in turn will allow us to onboard those groups more quickly. The tool is built to guide the Producer through the information Regence needs so we can collect all the necessary information and attachments. Notes: The egma is not currently available for Dental Only groups. To help onboard the group quickly and efficiently, please send the Online Enrollment Spreadsheet to the group as early as possible. 1. From Producer Center, select the quote the group has chosen. 2. Work through the guided egma on behalf of the group. Information: It is recommended to select the Save button when moving from screen to screen, and when changes are made to answers on a screen. 3. The egma Tool will provide a list of documents that need to be attached based the group information provided. 4. Once the egma Tool is complete, send the egma to the group for their electronic signature and attachments. 5. Once the group has electronically signed the egma and attached all required documents, they will send it back to you. 6. Upload the group the Spreadsheet Enrollment so they can provide accurate online enrollment information. 7. Review the signed egma to make sure all necessary information and attachments are complete, and submit the egma and attachments to Regence. 8. There are new statuses built into the system to provide the Producer insight into where the group is within the onboarding process. File Name: 2018 egma or_cc producer manual Page 4 of 37 Printed: January 22, 2018

5 Starting an egma Starting a New egma. Important: The egma Tool requires pop-ups. Enable pop-ups following your browser s instructions. If you don t want to enable all pop-ups you can add the url: chs1.force.com to your Trusted Sites within your browser. 1. Prepare the quote within Producer Center as you would normally. Be sure to include all benefits the group may want. Once the egma is initiated benefits from the quote can be de-selected, but cannot be added. Notes: The egma is not currently available for Dental Only groups. If a group has an effective date change and an egma has already been submitted to Regence, before copying the quote you need to Cancel the previously submitted egma. If the egma has not been submitted to Asuris yet, you only need to copy the quote. 2. After reviewing the quote, select Start egma. Starting an egma from a Previously Prepared Quote 1. From Producer Center select Group Business. 2. Select the appropriate Opportunity from the list of Opportunities. 3. From the Opportunity displayed, scroll to the bottom of the screen to the Quote List. Find the appropriate quote, and select the down arrow on the right side of the screen. 4. Select Start egma from the list of options. 5. A summary of the quote will be shown. At the bottom of the screen select Continue with egma Creation. Once the egma tool has been launched from the selected quote. You can select egma to view the egmas in progress and their statuses. Important: If you select Start egma for an egma that is in progress, you will receive a message warning you that the new egma will delete all data from the original egma. File Name: 2018 egma or_cc producer manual Page 5 of 37 Printed: January 22, 2018

6 Resuming Work on a Previously Saved egma Follow these instructions to begin working on a previously saved egma. 1. From Producer Center select egma. 2. Select Open. Submitted and Onboarding Status are for viewing egmas that have been signed and submitted to Regence. 3. You will see a listing of all Open egmas and their statuses. 4. Select the Group s Legal Name of the egma for which you would like to continue working. Viewing Status of egmas There are a few different ways you can view the status of your egmas. List View To view the status of egmas in a list format, follow the same process you would for resuming work on a previously saved egma. 1. From Producer Center select egma. 2. Select Open. Submitted and Onboarding Status are for viewing egmas that have been signed and submitted to Regence. 3. You will see a listing of all Open egmas and their statuses. File Name: 2018 egma or_cc producer manual Page 6 of 37 Printed: January 22, 2018

7 Kanban View You can also get a snapshot view of the egmas, and track them as they move through the process by viewing them via the Kanban view. 1. From Producer Center select egma. 2. Select Onboarding Status. 3. On the right side of your screen there are six boxes. Choose the second box, and select Kanban. What these categories represent Group Application The egma and accompanying paperwork has been started. Application Review The egma has been signed, submitted, along with required paperwork, to Regence, and is being reviewed. Implementation The group has been Marked Sold, and the group is being set up. Member Enrollment Membership is being set up so that cards can be ordered. File Name: 2018 egma or_cc producer manual Page 7 of 37 Printed: January 22, 2018

8 egma Tool Tabs Tabs The egma Tool is made up of several tabs (listed below). The Landing Page welcomes the Producer to the egma Tool. Landing Page Start Benefits Contact Group Enrollment Producer Attachments From there the Start tab provides questions to help make sure the group is eligible for coverage prior to completing the rest of the egma. Once the Start tab is complete you can move around the egma freely by selecting specific tabs, and by choosing Previous or Next within a tab. Saving While completing the egma you can save anytime by clicking the Save button located at the bottom of the egma screen. The egma will also save your progress as you move from screen to screen. Help Contact your Sales Representative f you need help while completing the group s egma. Landing Page Welcome to the online Regence Group Master Application (egma) Let s start the process for purchasing group coverage. To help you, we have pulled in information from the quote selected. Once you have completed and submitted the application, we'll finalize the rates based on the group's selections. Do you want to see this again? Select the box if you do not want to see this message again. Once selected you will not see this message for this egma in the future. If this is your first time entering this egma, select Start otherwise select Resume. Moving Throughout an egma When you are finished completing a screen, hit Next to continue to the next button or tab if you have completed the last button. Select Previous to move back to the preceding button or tab if you are on the first button tab. There are some screens that contain longer lists of questions. On these screens, you will need to scroll down to see the additional questions. File Name: 2018 egma or_cc producer manual Page 8 of 37 Printed: January 22, 2018

9 Attachments At the end of the egma, you will be prompted to upload attachments based on your selections throughout the egma. The required attachments aggregate to the Attachments tab. Note: A completed spreadsheet enrollment template is required to submit the egma. To help onboard the group quickly and efficiently, please send the Spreadsheet Enrollment Template to the group to complete as early as possible. The complete Spreadsheet Enrollment Template will be required prior to submitting the egma to Regence. Start Tab The questions within the Start tab are designed to help determine if the group is eligible for coverage. Once the Start tab has been completed, you will be able to move freely throughout the tabs. Information: It is recommended to select the Save button when moving from screen to screen, and when changes are made to answers on a screen. Start Tab - Button 1 Coverage Options Let's start with some basic information you have already provided in the quote. We have entered it on the groups egma. Please confirm this information is correct by selecting Next. If the information is not correct, select Cancel at the bottom of the screen (after which you will need to Copy and modify the quote). What is the group s choice of coverage? The answer will default to what was selected on the quote for Medical/Pharmacy/Vision and Dental. Maps to: OR/CC 1-50 GMA Section E - Administration Start Tab - Button 2 Coverage Options Data will be populated from the quote. Medical/Pharmacy/Vision The answer will default to what was selected on the quote. If the information is not correct, select Cancel at the bottom of the screen (after which you will need to Copy and modify the quote). Maps to: OR/CC 1-50 GMA Section E - Administration Employee and Dependents o (Oregon Only) If choosing Employee and dependents, then children, legal spouse, and Oregon-certified domestic partner are included. Will the group also include non-certified domestic partners? Yes/No Employee Only When electing Employee Only Coverage, dependents cannot be added to coverage under any employee during this contract period. Dependents include: spouse, children, domestic partner, court-ordered dependents, etc. This election cannot be changed until the next renewal. File Name: 2018 egma or_cc producer manual Page 9 of 37 Printed: January 22, 2018

10 Employee and Children When electing Employee and Children Only Coverage, please note that spouses and domestic partners cannot be added to coverage under any employee during this contract period. This election cannot be changed until the next renewal. If Yes, you have indicated that the group is including non-certified domestic partners. Will the group be enrolling non-certified domestic partners for the requested effective date? Yes/No If Yes, the group will need to submit affidavits for these employees. These forms can be uploaded on the Attachments tab. Dental The answer will default to what was selected on the quote. If the information is not correct, select Cancel at the bottom of the screen (after which you will need to Copy and modify the quote). Maps to: OR/CC 1-50 GMA Section E - Administration Employee Only Employee and Dependents When electing Employee Only Coverage, dependents cannot be added to coverage under any employee during this contract period. Dependents include: spouse, children, domestic partner, court-ordered dependents, etc. This election cannot be changed until the next renewal. o (Oregon Only) If choosing Employee and dependents, then children, legal spouse, and Oregon-certified domestic partner are included. Will the group also include non-certified domestic partners? Yes/No If Yes, you have indicated that the group is including non-certified domestic partners. Will the group be enrolling non-certified domestic partners for the requested effective date? If Yes, the group will need to submit affidavits for these employees. These forms can be uploaded on the Attachments tab. Start Tab - Button 3 Other Carrier Coverage Information: Dual carrier offerings in this market segment is not allowed. Will the group offer other coverage with another carrier to its eligible employees? Maps to: OR/CC 1-50 GMA Section D Group Information Medical Yes/No If Yes, Dual carrier offerings in this market segment are not allowed. If Yes is selected, the group is not eligible for the selected coverage. Dental Yes/No If Yes, Dual carrier offerings in this market segment are not allowed. If Yes is selected, the group is not eligible for the selected coverage. Start Tab - Button 4 Current Coverage Does the group have current coverage? Yes/No Maps to: OR/CC 1-50 GMA Section D Group Information If Yes, select the Current Medical Carrier and/or Current Dental Carrier, as applicable. File Name: 2018 egma or_cc producer manual Page 10 of 37 Printed: January 22, 2018

11 If the current medical and/or dental carrier is not listed, select Other and enter the name of the other carrier in the space provided. Start Tab - Button 5 Coverage for Enrolled Employees (Oregon Only) This page is intentionally blank with no action required. Please proceed by selecting Next. (Clark County Only) Information: To qualify for a group health plan under clarified common-law rules, at least one employee must be enrolled. Employees, for this purpose do not include: Maps to: CC 1-50 GMA Section E - Administration a. A self-employed individual b. A sole proprietor of the sponsoring business or the sole proprietor s spouse c. An individual that wholly owns a corporation that is the sponsoring business, or wholly owns the corporation with his/her spouse (except a corporate officer who is an employee as defined in 26 CFR (d)-1(b)) d. A partner in a partnership sponsoring the plan or the partner s spouse (except a bona fide partner as defined by law in 45 CFR section (c)(2)) Will the group have at least one employee enrolled as of the effective day of the coverage? Yes/No If Yes, you will continue to the next question. If No, the group should have at least one employee enrolled as of the effective day of coverage to continue. If they do not, the group is not eligible for coverage. Do you want to revisit this question again? Yes/No o o If Yes, you will be given an opportunity to change the answer. If No, would you like to end your session? Yes/No If Yes, the session will end, the record will close, and you will be taken to the GMA Group Applications list view in Producer Center. If No, you will be returned to the top of the page with no response populated. Start Tab Button 6 ACA Requirements Information: ACA requires us to record the group s (and all affiliates ) average number of employees for the preceding completed calendar year. This count includes the following local & worldwide employees: full-time, part-time, seasonal, union workers, as well as business owners, corporate officers, and partners if they are also employees. The count does not include contracted 1099 individuals or nonemployees. An employer who was not in existence throughout the preceding calendar year may estimate the average number of employees they expect to employ in the current calendar year. 1. What is the preceding calendar year? Select the applicable year. 2. The average number of employees (for ACA) was: Enter the average, accounting for the number of employees in the group and any affiliated businesses. Maps to: OR/CC 1-50 GMA Section D Group Information File Name: 2018 egma or_cc producer manual Page 11 of 37 Printed: January 22, 2018

12 Start Tab Button 7 Verification of Group Size (Clark County Only) This page is intentionally blank with no action required. Please proceed by selecting Next. (Oregon Only) Verification of Group Size We need some information about eligible employees to verify the size of the group. We are looking for the average number of full-time and full-time equivalent employees combined in the preceding calendar year. An employer who was not in existence throughout the preceding calendar year may estimate the average number of employees they expect to employ in the current calendar year. Please account for the number of employees in the group and any affiliated businesses. Maps to: OR 1-50 GMA Section D Group Information Would you like to simply enter the value or would you like to use the calculator? I would like to enter the value. Please enter the average number of full-time and full-time equivalent employees combined in the preceding calendar year. I would like to use the calculator. o Let s start with the Full-time Employee Calculation. For each month of the preceding calendar year, total the number of full-time employees working an average of 30 hours or more per week during the month or 130 hours or more during the month. Based on your input, your average full-time employees in the preceding calendar year is xxx. This value is derived by dividing your yearly total full-time employees above by 12 (since there are 12 months in a year). This number is rounded down to the nearest whole number. o Let s continue to the Full-time Equivalent Employee Calculation. For each month of the preceding calendar year combine the number of hours of service for the month for all employees working less than 30 hours per week but do not include more than 120 hours per employee. Please account for the number of employees in the group and any affiliated businesses. If the total number of hours worked isn t a whole number, round it down to the nearest whole number. Based on your input, your average full-time equivalent employees in the preceding calendar year is xxx. This value is derived by adding the employee hours listed each month together and dividing by 120, then taking the result and dividing by 12 (since there are 12 months in a year). File Name: 2018 egma or_cc producer manual Page 12 of 37 Printed: January 22, 2018

13 o o Based on your input your average full-time equivalent employees in the preceding calendar year was xxx. The average number of full-time and full-time equivalent employees in the preceding calendar year was xxx. o This value is derived by adding your average full-time employees to your average fulltime equivalent employees in the preceding calendar year. File Name: 2018 egma or_cc producer manual Page 13 of 37 Printed: January 22, 2018

14 Benefits Tab As you select networks and benefits they will populate on the right side of the egma screen (see the sample below). If you do not see the benefits needed for the group, select Cancel at the bottom of the screen (after which you will need to Copy and modify the quote to add the needed benefits). Benefits Tab - Button 1 Network Selection Let s take a look at the group s network and benefit selections. The following networks and benefits were on the quote you selected to initiate the GMA. Please confirm the group s choices by selecting the benefits you would like to purchase for your group. Information: The options listed on each of the Benefits screens reflect options chosen for the specific quote. If more options are desired you will need to Copy and modify the quote, and restart the egma from the copied quote. Please confirm the group s network selections by selecting them from the list below. Please note the Preferred network is required. The group s network is the Preferred Network, and is prechecked. Benefits Tab - Button 2 Medical Benefit Selection Please confirm the group s choices by selecting the Regence Employee Choice medical benefits the group would like to purchase. Offering two to three benefit options is ideal for most groups (maximum of five benefit options). The chosen medical benefit(s) will populate within the Benefit Selections on the right side of the screen. Maps to: OR/CC 1-50 GMA Section F Benefit Options Health Savings Account (HSA) If an HSA plan has been chosen you will be offered the following choices. Looks like the group has selected an HSA Healthplan in the Medical Benefits Section. File Name: 2018 egma or_cc producer manual Page 14 of 37 Printed: January 22, 2018

15 We offer integration with HealthEquity, an HSA Administrator. This integration allows HealthEquity to automatically set up health savings accounts for each employee enrolled on one of our HSA Healthplans and offers employees the ability to pay providers directly from their HSA. Will the group elect HealthEquity to administer their HSAs? Yes/No If Yes, who will be paying the monthly HSA fee? o Employer o Employee Since the group has elected to have HealthEquity administer the HSA plan(s), the Group Administrator should expect to receive a Data Extract Agreement (DEA) via DocuSign in the coming weeks. The DEA must be signed to allow HSA enrollment information to be sent to HealthEquity. If No, in the space provided please enter the name of the bank the group will be using for their HSA. Benefits Tab - Button 3 Additional Coverage Options Please confirm the group s additional coverage options. The chosen additional coverage options will populate within the Benefit Selections on the right side of the screen. If there are no applicable additional coverage options, this section will say None. Maps to: OR/CC 1-50 GMA Section F Benefit Options Benefits Tab - Button 4 Medical Rate Structure (Oregon Only) Medical Rate Structure The Group s rate structure is Composite. This data is for informational purposes only and no action is required. Please proceed by selecting Next. Maps to: OR 1-50 GMA Section F Benefit Options (Clark County Only) Medical Rate Structure Please select the Medical Rate Structure. Maps to: CC 1-50 GMA Section F Benefit Options Benefits Tab - Button 5 Dental Benefit Selection Please confirm the group s choice by selecting the dental benefit the group would like to purchase. The chosen dental benefit will populate within the Benefit Selections on the right side of the screen. If Dental was not quoted, this screen will say None. Maps to: OR/CC 1-50 GMA Section F Benefit Options Contact Tab Contact Tab - Button 1 Group Contacts Note: You will need to scroll down the screen to see all the options available. Maps to: OR/CC 1-50 GMA Section B Contact Information File Name: 2018 egma or_cc producer manual Page 15 of 37 Printed: January 22, 2018

16 1. Executive Contact (President, Owner, etc.) Complete the First and Last Name, Phone, Contact Title, Fax, and fields. Information: The Executive Contact will receive the GMA via for their signature. Please ensure that the address is correct. 2. Group Administrator Is the executive contact also the group administrator? Yes/No If Yes, the Executive Contact information will be copied into the Group Administrator Contact fields on the GMA. If No enter a different contact Complete the Name, Phone, Job Title, Fax, and fields. 3. Primary Billing Contact Is the group administrator also the primary billing contact? Yes/No If Yes, the Group Administrator information will be copied into the Primary Billing Contact fields on the GMA. If No enter a different contact Complete the Name, Phone, Job Title, Fax, and fields. 4. Employer Center Contact Maps to: OR/CC 1-50 GMA Section E - Administration The Employer Center account will be registered to a primary user at the group. We will send an to this user with registration instructions once the group is set up. Will the group administrator also be the Employer Center primary user? Yes/No If Yes, the Group Administrator information will be copied into the Employer Center Contact fields on the GMA. If No enter a different contact Complete the Name, Phone, and fields. Contact Tab Button 2 Billing Preferences Let s discuss billing preferences. Payment Method The payment method the group prefers is: Maps to: OR/CC 1-50 GMA Section E - Administration Pay by Check Payment is due upon receipt of the first billing invoice. Binder checks are not required. ACH Pull (Surepay) o The group has chosen ACH Pull. We will need the group to complete the Group Surepay Authorization form located on the Attachments tab. Information: If your group authorizes an ACH pull, their bank may block these on their account. Please advise the group to inform their bank that they have approved this ACH Pull. ACH Push File Name: 2018 egma or_cc producer manual Page 16 of 37 Printed: January 22, 2018

17 Invoices Does the group require separate invoices? Yes/No Maps to: OR/CC 1-50 GMA Section A Group Name & Address If Yes, complete the following fields. Let s first get the address information of the separate billing. List additional billing locations, as needed, by selecting the Add Billing button. You can also remove unneeded billing locations by selecting the Remove Billing button. List the billing name and address. o Group name to appear on billing o Address o City o State o ZIP Code Contact Tab - Button 3 Third-Party Administrator (TPA) Additional Contacts Some groups work with a Third-Party Administrator (TPA). If there is not a TPA, please select No and Next. If there is a TPA, please select Yes and give us more information about them. Yes/No Maps to: OR/CC 1-50 GMA Section A Group Name & Address If Yes, complete the following fields. o TPA Name o Contact Name o TPA Address o City o State o ZIP Code o Phone o o What services does the group use the TPA for? (select all that apply) Billing COBRA You have indicated that the group is subject to COBRA. Does the TPA submit COBRA enrollment/disenrollment directly to Regence? Yes/No Would the group like us to send the invoice for COBRA participants to the TPA at address provided above? Yes/No Eligibility Other Group Tab Group Tab - Button 1 Group Name Maps to: OR/CC 1-50 GMA Section A Group Name & Address File Name: 2018 egma or_cc producer manual Page 17 of 37 Printed: January 22, 2018

18 1. Group Legal Name Validate/enter the group s legal name in the field under Group Name. 2. Does the business go by any other name? Yes/No If Yes, enter the other business name in the field under DBA Name. a. What name should we use? Information: We will use this name on your ID cards, group billing, and mail. Group Legal Name DBA Name Group Tab - Button 2 Physical and Mailing Addresses and Headquarters Maps to: OR/CC 1-50 GMA Section A Group Name & Address 1. Group Physical Address Validate the group s physical address, and add the County. Information: Please include complete address (i.e. Suite number). Post Office Boxes (P.O. Boxes) and Private Mail Boxes (PMB) are not physical addresses and cannot be used. 2. Is the group s headquarters address the same as the group s physical address? Yes/No If Yes, the Group Physical Address information will be copied into the Group Headquarters City and State fields on the GMA If No, o Group headquarters City o Group headquarters State 3. Is the group mailing address the same as the group physical address? Yes/No If Yes, the Group Physical Address information will be copied into the Group Mailing Address fields on the GMA If No, enter the Group Mailing Address in the fields provided. 4. Is the billing address the same as the mailing address? Yes/No Information: This question will not appear if separate billing invoices were requested (see the Contact Tab, Button 2). If Yes, the Mailing Address information will be copied into the Billing Address fields on the GMA If No, enter the Billing Address in the fields provided. Group Tab - Button 3 Tax IDs Maps to: OR/CC 1-50 GMA Section A Group Name & Address Federal Tax ID Number (EIN) Information: Please enter the 9-digit EIN with no dashes. (Clark County Only) State Tax ID (UBI) Information: Please enter the 9-digit UBI with no dashes. File Name: 2018 egma or_cc producer manual Page 18 of 37 Printed: January 22, 2018

19 Group Tab - Button 4 Business and Industry Business and Industry Maps to: OR/CC 1-50 GMA Section D Group Information 1. Type of Business Please choose the group's type of business from the options below. If the business is a Limited Liability Company (LLC), please choose the option that matches how the business files with the IRS. If selecting 'Other' please explain in the provided box. If Other is selected, please provide an explanation in the provided box. 2. What date did the business start? Select the date. 3. Are there affiliated businesses? Yes/No Information: Companies with a common owner or that are otherwise related under rules of section 414 of the Internal Revenue Code are generally combined and treated as a single employer for determining employer group size. o If Yes, enter the name of affiliated business(es) separated by commas. a. You indicated the business had an average of xxx employees in YYYY for ACA Does this count include employees from your affiliated business(es)? Yes/No If Yes, please see the Attachment Tab for the required Ownership Verification Form.. Does the quote include employees from your affiliated business(es)? Yes/No o If No, please revise your average number of employees now to include the employee count from your affiliated business(es). Validate the SIC Code and associated Industry Description. Workers Compensation 4. Choose the group s Workers Compensation Carrier from the list. o If Other, please list the name of the group s Workers Compensation carrier. o If None, please explain in the space provided. Group Tab - Button 5 Applicable Federal Mandates, Deductible, and Out of Pocket Accumulators Applicable Federal Mandates The group may be subject to any or all of the following 4 federal mandates which govern certain administration rules of group-sponsored healthcare plans. Basic, minimal criteria are provided to help determine applicability of each mandate. Maps to: OR/CC 1-50 GMA Section D Group Information COBRA Applies if group employed 20 or more employees for 50% or more of the typical business days in the preceding calendar year (excluding church and federal government groups). You may count a part-time employee as a fraction of a full-time employee. Is the group subject to COBRA? Yes/No File Name: 2018 egma or_cc producer manual Page 19 of 37 Printed: January 22, 2018

20 ERISA ERISA applies to most groups other than church and government entities. Is the group subject to ERISA? Yes/No o If Yes, enter the ERISA date in the space provided. Information: The ERISA plan year value will be displayed in MM/DD format. OBRA OBRA applies if group employed 100 or more employees (full-time and/or part-time) for at least 50% of the workdays of the preceding calendar year. Is the group subject to OBRA? Yes/No TEFRA/DEFRA Applies if group employed 20 or more employees (full-time and/or part-time) for each working day in each of 20 or more calendar weeks in the current or preceding calendar year. Is the group subject to TEFRA/DEFRA? Yes/No Has the group s TEFRA/DEFRA status changed in the last year? Yes/No o If Yes, enter the date of change. Deductible and Out of Pocket Accumulators Maps to: OR/CC 1-50 GMA Section - Administration To comply with properly crediting amounts accumulated from the prior carrier, the group must confirm if amounts accumulated on a calendar year or a plan year (matching your contract renewal period e.g. renewal month is April, accumulation starts April 1 and ends March 31). Under the prior carrier, how were the deductible and out of pocket amounts accumulated? o o Calendar year Plan year If Plan year, enter the dates for the plan year accumulators with the prior carrier. Enter the Begin Date and End Date. Group Tab - Button 6 Enrollment Preferences The initial enrollment for the group will be spreadsheet enrollment. Important: A completed spreadsheet enrollment template is required to submit the egma for initial enrollment. The spreadsheet enrollment template is located on the Attachments tab. Select the preferred method for ongoing enrollment. Maps to: OR/CC 1-50 GMA Section E - Administration o o Online Enrollment Important: If the group has chosen both medical and dental plans, Online Enrollment is currently not an option for ongoing enrollment. Will the group allow employees to enroll themselves? Yes/No Will the group administrator participate in online enrollment? Yes/No Paper Enrollment Does the group have eligible employees in other states? Yes/No Maps to: OR/CC 1-50 GMA Section D Group Information File Name: 2018 egma or_cc producer manual Page 20 of 37 Printed: January 22, 2018

21 o If Yes, select the state(s) and in the spaces provided enter the number of employees in each state. (Employees residing in the state of Hawaii are not eligible due to specific Hawaii State Mandates.) Select +Add another state to add a state, and -Remove state to remove a state. Group Tab - Button 7 Class, Probationary Period, and Contribution We will now set up the group class information, probationary period and contribution. Maps to: OR/CC 1-50 GMA Section E - Administration 1. Will all eligible employees be offered the same contribution, probationary period, and benefit plans? Yes/No o If Yes, your group will be set up with one class. The default name is Active but you can give it a new name by typing it in the box below (see the following instructions Group Has One Class). o If No, Let s begin defining classes for determining the benefits and eligibility that will apply to each class. Employee class categories must be based on bona fide employmentbased employment classifications that are consistent with an employer s usual business practice. Common examples include: Management, Non-Management; Salaried, Hourly; etc. Enter the class names for the group. Please list the names as the group would like them to appear on the group billing invoice (see the following instructions Group Has Multiple Classes). Group Has One Class Your group will be set up with one class and it will be called Active (and can be renamed). The group has one class. Please specify the probationary period for this class. Information: A probationary period may not be waived or altered for a particular employee. Before adopting different probationary periods by employee class (hourly, salaried, etc.), consider seeking tax and/or legal advice. Premiums will be prorated for coverage effective dates other than the 1 st of the month. 1 st of the month following the date of hire o For this option, your selections must be consistent across all classes. When employees are hired on the 1 st of the month, do you want them to be effective on: The date of hire The 1 st of the next month 1st of the month following 30 days 1st of the month following 60 days On the actual date of hire On the actual 90th day File Name: 2018 egma or_cc producer manual Page 21 of 37 Printed: January 22, 2018

22 Group Has Multiple Classes Let s begin defining classes for determining the benefits and eligibility that will apply to each class. Employee class categories must be based on bona fide employment-based employment classifications that are consistent with an employer s usual business practice. Common examples include: Management, Non-Management; Salaried, Hourly; etc. Enter the class names for the group. Please list the names as the group would like them to appear on the group billing invoice. To add additional classes select + Add another class (if you add a class and need to remove it select Remove class). Please list the names as the group would like them to appear on the group billing invoice. Probationary Period Information: A probationary period may not be waived or altered for a particular employee. Before adopting different probationary periods by employee class (hourly, salaried, etc.), consider seeking tax and/or legal advice. 1 st of the month following the date of hire o When employees are hired on the 1st of the month, do you want them to be effective on: The date of hire The 1 st of the next month 1st of the month following 30 days 1st of the month following 60 days On the actual date of hire On the actual 90th day 2. When part-time employees transfer to full-time, when will their probationary period start? o On the original hire date (retroactive) o On the date the employee transfers to full-time hours 3. Will the group waive the probationary period on initial enrollment (new groups only)? Yes/No Group Tab - Button 8 Contribution Section Let s define the group s contribution. This chapter has separate instructions for groups with one class and groups with multiple classes. Maps to: OR/CC 1-50 GMA Section E - Administration Group Has One Class Your group has one class. Do you want to vary premium contribution by product? Yes/No Your group has one class. Do you want to vary premium contribution by product? Yes/No File Name: 2018 egma or_cc producer manual Page 22 of 37 Printed: January 22, 2018

23 If Yes, list the products they have selected on the quote and ask for the premium contribution percentage for each product. There is a minimum employer contribution percentage of 50% of employee premium of the lowest cost plan offered. Enter the percentage the employer will pay toward employee and dependent premium. Medical & Dental Enter the percentage the employer will pay toward employee and dependent premium. Dental Enter the percentage the employer will pay toward employee and dependent dental premium. o There is a minimum employer contribution percentage of 50% of employee premium of the lowest cost plan offered. If the Employee % is less than 50% you will be asked: Do you want to proceed? Yes/No If No, There is a minimum employer contribution percentage of 50% of employee premium of the lowest cost plan offered. Enter the percentage the employer will pay toward employee and dependent premium. As a reminder, there is a minimum employer contribution percentage of 50% of employee premium of the lowest cost plan being offered. File Name: 2018 egma or_cc producer manual Page 23 of 37 Printed: January 22, 2018

24 Group Has Multiple Classes The group has multiple classes. Do you want to vary medical benefit plans by class? Yes/No As a reminder, there is a minimum employer contribution percentage of 50% of employee premium of the lowest cost plan being offered. If Yes, There is a minimum employer contribution percentage of 50% of the employee premium of the lowest cost plan offered. Please enter the percentage the employer will pay toward the employee and dependent premium for each medical benefit being offered per class. If a particular medical benefit is not being offered to a class of employees, leave the employee and dependent contribution fields for that benefit blank. Dental benefits do not vary by class. Medical For each Class Name, enter the percentage the employer will pay toward employee and dependent premium. Dental For each Class Name, enter the percentage the employer will pay toward employee and dependent dental premium. There is a minimum employer contribution percentage of 50% of employee premium of the lowest cost plan offered. If the Employee % is less than 50% you will be asked: Do you want to proceed? Yes/No File Name: 2018 egma or_cc producer manual Page 24 of 37 Printed: January 22, 2018

25 If No, Information: As a reminder, there is a minimum employer contribution percentage of 50% of employee premium of the lowest cost plan being offered. Enrollment Tab Enrollment Tab - Button 1 Participation Requirements Let s talk about the group s employees in order to verify work hours and participation. Maps to: OR/CC 1-50 GMA Section E - Administration Work Hours What is the minimum number of hours employees are required to work to be eligible for coverage under this plan? Enter the number in the space provided. (Oregon Only) Information: Hours must be between 17.5 and 40. (Clark County Only) Information: Hours must be between 20 to 40. Participation Requirements For the following questions, please count each individual only once. Information: To be eligible for coverage, groups who have 1-3 eligible employees must enroll 100% of eligible employees after consideration of valid waivers. Groups of 4 or more employees must enroll at least 75% of the group s eligible employees after consideration of valid waivers. File Name: 2018 egma or_cc producer manual Page 25 of 37 Printed: January 22, 2018

26 1. What is the total number of employees on payroll (excluding COBRA and non-cobra continuation of coverage participants)? Enter the number in the space provided. Information: Include in this answer all employees on payroll including affiliated business(es) if the group is requesting coverage for the affiliated business(es). Do not include employees from affiliated businesses if the group is not requesting coverage for them. Also, include employees that are not eligible under this plan, but may be covered under another plan (for example, union employees). 2. How many employees work fewer than the group s minimum hours? Enter the number of employees who currently work the hourly requirement but haven t fulfilled the group s probationary period. These employees are not eligible. 3. How many employees are still serving the group s new-hire probationary period? Enter the number of employees who currently work the hourly requirement but haven t fulfilled the group s probationary period. These employees are not eligible. 4. How many employees are seasonal, substitute, or temporary? Enter the number in the space provided. These employees are not eligible. 5. How many individuals are contracted and income is reported via IRS Form 1099? Enter the number in the space provided. This answer should include individual contractors or other individuals whose income from the group is solely reported on IRS Form These employees File Name: 2018 egma or_cc producer manual Page 26 of 37 Printed: January 22, 2018

27 are not eligible. Self-employed individuals or owners may be eligible. Please contact your Sales Representative if you have questions. 6. (Clark County Only) How many employees are part of an employee segment that is ineligible for coverage under this plan (applies to groups of 10 or more enrolled employees, unless they are part of a union segment)? If the group has 10 or more enrolling employees, the group may decide not to cover a segment of their employees. If the group has under 10 enrolling employees the group may only exclude coverage for its union employees. Please enter the number of employees excluded from coverage. o Please provide a description of the group s ineligible employee segment. Select the appropriate answer. If Union is chosen, please upload a copy of the union roster on the Attachments Tab. If Other is chosen, please define the ineligible employee segment in the space provided. Based on your answers, the group has the subtotal of eligible employees displayed. (Oregon Only) The next several questions must be answered for both Medical and Dental coverage. 6. How many employees are waiving with other qualifying coverage? Enter the number in the Medical and/or Dental spaces provided. Include eligible employees that have other qualifying coverage. Other qualifying coverage includes: similar existing group coverage, Medicare, File Name: 2018 egma or_cc producer manual Page 27 of 37 Printed: January 22, 2018

28 Medicaid, VA, TRICARE, Individual, Indian Health, Christian Scientist, CHAMPUS. There should be waiver information for each individual in the Spreadsheet Enrollment Template Waiver tab. Based on your answers above, the group has the number of employees eligible to enroll displayed. 7. How many employees are declining coverage? Enter the number in the Medical and/or Dental spaces provided. Include eligible employees that have no other qualifying coverage and are not enrolling. There should be waiver information for each individual in the Spreadsheet Enrollment template Waiver tab. Based on your answers, the group has the number of employees enrolling displayed. Based on your answers, group s participation will be displayed. Information: Groups of 1-3 require 100% participation. Groups of 4 or greater require 75% participation. 8. How many individuals are enrolling on COBRA and non-cobra continuation of coverage? Enter the number in the Medical and/or Dental spaces provided. 9. How many former and current employees and/or dependents are eligible for COBRA and non- COBRA continuation of coverage but have not yet applied? Enter the number in the Medical and/or Dental spaces provided. (Clark County Only) The next several questions must be answered for both Medical and Dental coverage. File Name: 2018 egma or_cc producer manual Page 28 of 37 Printed: January 22, 2018

29 7. How many employees are waiving with other qualifying coverage? Enter the number in the Medical and/or Dental spaces provided. Include eligible employees that have other qualifying coverage. Other qualifying coverage includes: similar existing group coverage, Medicare, Medicaid, VA, TRICARE, Individual, Indian Health, Christian Scientist, CHAMPUS. There should be waiver information for each individual in the Spreadsheet Enrollment Template Waiver tab. Based on your answers above, the group has the number of employees eligible to enroll displayed. 8. How many employees are declining coverage? Enter the number in the Medical and/or Dental spaces provided. Include eligible employees that have no other qualifying coverage and are not enrolling. There should be waiver information for each individual in the Spreadsheet Enrollment template Waiver tab. Based on your answers, the group has the number of employees enrolling displayed. Based on your answers, group s participation will be displayed. Information: Groups of 1-3 require 100% participation. Groups of 4 or greater require 75% participation. 9. How many individuals are enrolling on COBRA and non-cobra continuation of coverage? Enter the number in the Medical and/or Dental spaces provided. 10. How many former and current employees and/or dependents are eligible for COBRA and non- COBRA continuation of coverage but have not yet applied? Enter the number in the Medical and/or Dental spaces provided. (Oregon & Clark County) Special Annual Enrollment Period If and only as required by law, a special annual enrollment period will be offered during a period defined by regulators for a January 1st effective date to small groups who do not meet the minimum contribution and/or participation rules. Minimum contribution and participation rules must be met for renewing groups. Please contact your Sales Representative if you have questions. Producer Tab Producer Tab - Button 1 Let s talk about the group s producer partner(s). Please confirm the following information. Please make appropriate changes if the information is incorrect. File Name: 2018 egma or_cc producer manual Page 29 of 37 Printed: January 22, 2018

30 Maps to: OR/CC 1-50 GMA Section C Producer Information Primary Producer Name Primary Producer Agency Primary Producer Number If there is a secondary producer, please provide their information below. Secondary Producer Name Secondary Producer Agency Name Secondary Producer Number Enter the commission split (if applicable). Medical Producer 1: % Producer 2: % Dental Producer 1: % Producer 2: % Attachments Tab Attachments There are documents that are required prior to submitting the signed egma to Regence. To download documents needed for your group to your PC, select Download. To upload completed documents, select Browse for Upload, locate the completed document on your PC, and select Open. o File names must be <50 characters. o You can find the uploaded document at the bottom of the Attachments screen. Select Upload Files to upload the completed documents to the egma Tool for sharing with the group or Regence. Important: Refresh your internet session to see the attachments after they have been uploaded. The attachments are divided into the following categories. Each of these categories will be populated with the specific documents needed for your group. Required Attachments Participation Verification Documents Optional Attachments The following attachments are necessary for onboarding this group. These attachments can either be added now in the mentioned areas below or added later by the group after selecting Share with Group. Sharing with the group initiates communication with the group to obtain their signature and remaining attachments through DocuSign. Once signed, the egma will be in Producer Center for your review. When you are ready to submit the GMA for processing, select Submit. You can see the status of the egma in Producer Center. File Name: 2018 egma or_cc producer manual Page 30 of 37 Printed: January 22, 2018

31 Previewing the egma To preview a PDF of the egma, all Tabs must have been completed and have the green checkmark. 1. Select Save prior to previewing. 2. Select the Preview button at the bottom of the screen. Note: You may notice there is an overflow page after the completed egma PDF. This contains information entered that does not fit within the egma PDF itself. Sharing the egma With Group for Signature To send the egma to the group for signature, you must have all tabs (except the Attachments Tab) completed, and have previewed the egma to make sure all answers are accurate. Information: Be sure to validate the Executive Contact s address. If the address needs to be updated, be sure to select Save after the update has been made. The egma will be sent to the address identified on the Executive Contact. 1. Select Share With Group to send the egma. File Name: 2018 egma or_cc producer manual Page 31 of 37 Printed: January 22, 2018

32 Group s Review and Signing When you share the egma with the group, an will be sent to the address listed within the Executive Contact. The primary options the Executive Contact will have are: Continue Other Actions o Finish Later Allows the signer to complete the signing ceremony later. o Print & Sign o Assign to Someone Else Allows the signer to assign someone else signer in zer place. o Decline to Sign Allows the signer to not sign in case there is something incorrect within the egma. Continue 1. The Executive Contact selects Continue. The egma PDF is available for viewing. 2. The Executive Contact selects Start to begin reviewing. 3. The Executive Contact can scroll or select Next to move from page to page through the PDF. 4. On the Signatures Section of the GMA PDF there will be a yellow highlighted box that says Sign. 5. Scrolling further takes the Executive Contact to the Attachments Section. a. On the Attachments Section the Executive Contact can upload required documents by selecting the highlighted yellow box with an arrow and paperclip. File Name: 2018 egma or_cc producer manual Page 32 of 37 Printed: January 22, 2018

33 i. Select Upload A File. ii. Browse for the appropriate file, select Open. The file will be uploaded to the egma. iii. After the file loads select Done. iv. If the wrong file was uploaded, prior to signing, the Executive Contact can select the small x after the document name to remove it, and replace it with the correct document. File Name: 2018 egma or_cc producer manual Page 33 of 37 Printed: January 22, 2018

34 v. To view the PDFs of documents loaded, scroll further. b. Once the required documents have been uploaded, the Executive Contact must approve the following statement by clicking the radio circle boxed in red. 6. To Finish the signed egma and send back to the Producer, the Executive Contact will select Finish. a. The Executive Contact will be prompted to sign the document by: Selecting a Style of signature Drawing a signature, or Uploading their own signature file. b. After signing, the Executive Contact will select Adopt And Sign. c. The Executive Contact will again select Finish. 7. The Executive Contact will receive the message below, and will have the options to: o Download a combined PDF or Separate PDFs o Print the PDFs o Log In, or o Select No Thanks to end the session. 8. You will receive an indicating the egma has been signed, and the status in Producer Center will show Ready for Review. Declines to Sign If the group finds something incorrect on the egma they can select Decline to Sign. 1. The Executive Contact will be prompted to provide a reason for declining. File Name: 2018 egma or_cc producer manual Page 34 of 37 Printed: January 22, 2018

35 2. The status within Producer Center will indicate Returned Unsigned. Touch base with the group to find out what issues caused them to decline to sign. 3. You will receive an indicating the group has declined to sign, and the reason they provided. 4. The egma can be edited now. Please update the egma per the group s request. Information: It is recommended to select the Save button when moving from screen to screen, and when changes are made to answers on a screen. 5. Select Reshare With Group. Submitting an egma to Regence To submit a signed egma to Regence all Tabs must be complete, and all documents listed on the Attachments must be uploaded. Important: To avoid delays, please review all forms for completeness and accuracy, and make sure forms requiring a signature are signed. By selecting Submit egma, you are attesting that the information provided is complete and accurate. Select Submit again. Select OK after receiving the following message: Thank you for submitting the egma on behalf of <group name>. The GMA reference number is. We are reviewing your submission. Status updates will be available to you on Producer Center." To resubmit missing information to Regence select Resubmit. File Name: 2018 egma or_cc producer manual Page 35 of 37 Printed: January 22, 2018

36 Printing and/or Saving a Copy of the egma Once the group has signed the egma, and it has been submitted to Regence you can print and/or save a copy of the egma. 1. From Producer Center, select egma. 2. Select Submitted. 3. Select the group. This will open the egma Tool. 4. Select the Attachments tab. 5. Select the document you would like to print and/or save. Producer Center egma Statuses Many statuses have been added to Producer Center to help you know where your group is within the process. Status In Progress Shared with Group Ready for Review Cancelled Submitted Returned Unsigned In Sales Review Description This is the status you will see when you start the egma. This is the status you will see when you select Share with Group to send the egma to the group for signature. This status indicates the group has signed GMA. This status indicates the egma has been cancelled by selecting the Cancel button. This status indicates you have submitted the egma to Regence by selecting the Submit button. This status indicates the group has declined to sign. An will be sent including any notes the group s Executive Contact provides regarding why ze declined. This status indicates the submitted egma is in work by Sales. File Name: 2018 egma or_cc producer manual Page 36 of 37 Printed: January 22, 2018