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Frequently Asked Questions 1. WORKERS' COMPENSATION Q: I have heard that I can exclude myself from Workers' Compensation; is this true? A: Corporate officers are automatically included unless they elect to be excluded. Sole Proprietors, Partners, and Members of LLC's are automatically excluded unless they elect to be included. If you elect to be excluded, some health insurance policies will not cover a work related injury. Contact your agent or carrier to determine how you are affected. 2. HEALTH INSURANCE Q: I am leaving my job and want to avoid any gap in health insurance coverage while I am looking for a new job. What are my options? A: Typically, depending upon the size of your soon to be previous employer, you will be given the opportunity to continue on the employers plan for a certain length of time; however, you must pay the premium . You may also want to consider a short term health insurance policy or purchasing an individual health insurance policy, depending upon both your current health and financial status. Q: My baby is due in three months; will it automatically be covered under my health insurance policy? A: Your child will be covered under your insurance policy for thirty days only. You must notify the insurance company, in writing, within thirty days of your child's birth, to add them as a dependent on your insurance policy. 3. PROFESSIONAL LIABILITY INSURANCE Q: How do I report an incident? A: During normal business hours, you may contact your insurance agent. If it is after business hours, your agent's answering service should provide an 800 number so that you can contact the insurance company directly. Q: What is EPLI coverage? A: Employment Practices Liability Indemnity coverage. This goes beyond defense coverage to include payment for settlements or judgments up to the limit of liability and subject to policy terms, conditions, and exclusions. The employer becomes obligated to pay for claims arising from a wrongful employment practice, sexual harassment, wrongful discharge, and discrimination. Q: What is the difference between a "claims made" policy and an "occurrence" policy? A: "Occurrence" provides for an injury or damage which takes place during the policy period, regardless of when the claim is reported. Under "claims made", coverage is provided for claims made and reported to the insurance company while the policy remains in force. 4. GROUP LIFE AND DISABILITY Q: I have group life and disability insurance through my association plan. Will my coverage automatically increase when I get a raise next year? A: You must request, in writing, to increase your benefit, within thirty days of being notified of a change in salary, to qualify for guaranteed issue. 5. SECTION 125 PLANS Q: What is a Section 125 plan and what types of expenses are covered under it? A: A Section 125 plan provides the option for employees to select certain benefits normally paid on an after-tax basis and, through salary reduction, pay for these benefits on a pre-tax basis. For a full listing of covered expenses, please visit www.eflexgroup.com. 6. DENTAL INSURANCE Q: Are individual dental insurance plans available? Is there a waiting period before my benefits begin? A: Yes, individual plans are available. Typically, your exam and cleaning will be covered once your policy is in force; for most other procedures, there is a waiting period. Q: What is "Direct Reimbursement?" A: Direct Reimbursement is an innovative method of self-funding whereby the plan reimburses employees for any expenses incurred, or a specified portion thereof, during a plan year. Benefits are expressed in maximum dollar limits per year or a percentage thereof. DR plans are self-funded. That means that no insurance company is involved in the design, marketing or administration of a DR plan. DR plans are stated in dollar maximums and percentages of the maximum per year. They differ from a traditional plan in that there is no list of covered and non-covered services. All treatments are covered depending on the amount of funds that remain in the employee's dollar yearly limit. |
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