Service Description

WageWorks
COBRA Services (CX)

 

The following is a description of general rights and obligations with respect to COBRA administration and other federal notice services (“Services”) provided by WageWorks.  Only those Services described below that are specifically chosen by you and for which the applicable fee is paid will be provided by WageWorks. 

You have independently concluded that one or more of your Health Plans are subject to the provisions of COBRA and/or the portability provisions of HIPAA. Consequently, you are required to perform certain acts in order to comply with COBRA and/or HIPAA.  You have requested WageWorks to assist you with satisfying certain of your obligations under the aforementioned COBRA rules, as follows:  

  1. CLIENT'S RESPONSIBILITIES

 You shall: 

a)    Timely furnish to WageWorks all information that WageWorks has determined is necessary for WageWorks to provide the Services, including, without limitation, the following: 

1)    Notify WageWorks of the annual Open Enrollment Period.   

2)    Determine which individuals are eligible to participate in your Health Plan(s) and provide us with accurate and complete eligibility data in the prescribed electronic data file format.  

3)    Provide accurate and timely changes to Continuant enrollment and eligibility data, including, but not limited to, information that modifies a Continuant’s eligibility, status or election under a Health Plan, in the electronic data file format prescribed by WageWorks. 

4)    Notify WageWorks in writing of any changes in carriers and/or Health Plan(s) at least sixty (60) days prior to the effective date of the change. 

5)    Notify WageWorks in writing of any changes in premiums that shall apply at least sixty (60) days prior to the effective billing date of the new premium.  

b)    Review all requests for reinstatement by a former Continuant or any other written request for review or determination concerning the terms and conditions of the Health Plan(s).   

c)    Be solely responsible for making eligibility determinations under the Health Plan(s). 

d)    Be solely responsible for reviewing all reports submitted by WageWorks and notifying WageWorks of any errors of which you become aware as soon as reasonably practicable after reviewing the reports, but no later than ninety (90) days after the report is rendered.  Any error(s) identified by you more than ninety (90) days after the initial report is rendered will be null and void, and WageWorks will not be liable for any discrepancies associated with any errors reported after ninety (90) days. 

e)    Obtain all required consents from Continuants necessary to disclose PHI to WageWorks for the provision of Services. 

f)     Correct all errors in any data, files or other materials provided to WageWorks by you or on your behalf by your third party service providers (e.g., carriers, payroll/pension data providers).  WageWorks does not audit data, files or other information provided by you or your third party service providers. 

g)    Timely pay all fees. 

h)    Timely pay all costs, including postage (billed at then-current USPS First Class Mail rates), print, copying and travel charges.  

i)      Manage access to the employer portal of our website by your personnel based upon your internal confidentiality and HIPAA privacy policies and procedures. 

j)      Comply with all applicable laws with respect to your Health Plan(s) and make any required filings with the appropriate governmental agencies, including the Department of Labor and the Internal Revenue Service.

 

 II. WAGEWORKS RESPONSIBILITIES 

WageWorks shall: 

a)    Provide you with a set of electronic file specifications for the delivery of data to WageWorks. 

b)    Process data files submitted by you in the electronic data file format prescribed by WageWorks. 

c)    Send the following Notices in accordance with the terms of the service agreement between you and WageWorks and WageWorks’ standard operating procedures, as set forth in further detail below, subject to the timely receipt from you of all information necessary for WageWorks to complete the Notices sufficiently in advance of applicable deadlines. 

 COBRA Notices

    • Federal COBRA Notices in accordance with 29 C.F.R. 2590.606 (as amended from time to time).
    • WageWorks’ standard COBRA General Notice, as soon as reasonably possible, but no later than seven (7) business days after receiving from you the information necessary for WageWorks to complete and send the COBRA General Notice.
    • WageWorks’ standard COBRA Election Form, as soon as reasonably practicable, but no later than fourteen (14) days after receiving from you or the Qualified Beneficiary (as applicable) the information necessary for WageWorks to complete and send the Election Form.
    • WageWorks’ standard Notice of Unavailability of COBRA (as required by 29 C.F.R. 2590-606-4(c)), as soon as reasonably possible, but no later than fourteen (14) days after receiving notice from the Continuant.
    • WageWorks’ standard Notice of Termination indicating that COBRA coverage is terminating or has terminated, within a reasonable amount of time after COBRA coverage has ended. 

d)    Send each Notice by first-class mail to the last known address on record with WageWorks.  WageWorks is not responsible for resending any Notice that is returned to WageWorks if the Notice was mailed to the last-known address on record with WageWorks.  

e)    Based on your election of a standard, comprehensive or custom open enrollment services, WageWorks will: 

Conexis Cobra Table

f)     Process COBRA enrollment and change forms submitted directly by Qualified Beneficiaries and/or Continuants through proper methods (e.g., WageWorks’ website).  Enrollment and elections will be considered timely made if the form is postmarked by the U.S. Postal Service or express delivery service within the applicable statutory period or Open Enrollment Period. 

g)    Provide monthly premium payment coupons to Continuants. 

h)    Maintain records regarding Notices sent for a period of eight (8) years. 

i)      Establish a process for Continuants (or a third party on behalf of the Continuant) to pay the required COBRA premiums to WageWorks.  WageWorks deems all premiums received by WageWorks to be timely made based on the United States Postal Service postmark date or on the date received if made through accepted electronic funds transfers.  

j)      Deposit all premiums received by WageWorks into an account maintained by WageWorks on behalf of its clients.  

k)    Send you all timely and completed premiums received by WageWorks during the applicable month.  This amount may be reduced by the two percent (2%) administrative fee and any other applicable fees (unless a different payment method is agreed to by the parties) no later than ten (10) business days after the end of the month in which the premiums were received by WageWorks.  WageWorks may submit premiums to appropriate third parties upon written instructions from you; additional administrative fees may apply. 

l)      Respond to inquiries by providers and/or insurance carriers regarding coverage status of Qualified Beneficiaries and Continuants within a reasonable period of time after receiving the inquiry.  All responses will be based solely on the information provided by you and maintained by WageWorks. 

m)  Forward to you for review all requests for reinstatement submitted by former Continuants to WageWorks, as well as any other written request for review or determination submitted to WageWorks concerning the terms and conditions of the Health Plan(s).  WageWorks is not responsible for making eligibility determinations under the Health Plan(s). 

n)    Provide to you scheduled reports detailing COBRA activities.  Upon request, WageWorks will also provide scheduled reports detailing COBRA activities to additional recipients designated by you.  Sending reports to non-Client recipients (e.g., a health insurance carrier) is subject to an additional fee.  WageWorks will work with you to resolve any errors that you notify WageWorks about within ninety (90) days after a report is rendered.  Any error(s) identified by you more than ninety (90) days after the initial report is rendered will be null and void and WageWorks will not be liable for any discrepancies associated with any errors reported after ninety (90) days. 

o)    Provide to you a detailed report of WageWorks’ COBRA administrative service activities during the preceding month no later than ten (10) business days following the last day of such month. 

p)    Provide you with access to our website where you may:

    • View and download standard reports
    • View individual account information
    • Access to our online communications gateway and download standard electronic communication material at no additional charge.  Customized items may be provided for an additional fee, plus charges for applicable bulk sales, taxes, shipping and handling.

q)    Provide you with a client services representative to answer phone or email inquiries by your staff regarding any service matters during the period of 9:00 a.m. (ET) to 6:00 p.m. (ET), Monday through Friday, excluding holidays and other non-business days.

r)     Provide customer service representatives who are available to answer Qualified Beneficiary and Continuant phone calls during the period of 8:00 AM ET to 8:00 PM ET, Monday through Friday, excluding holidays and other non-business days. 

s)    Provide Qualified Beneficiaries and Continuants with 24/7 access (excluding scheduled maintenance) to our website where Participants can access information regarding their COBRA coverage. 

 

   III.  ADDITIONAL SERVICES 

In addition to the services set forth above, WageWorks may also provide you with the following optional services, as elected and subject to the payment of additional fees.  Optional services may include the following: 

a)    HIPAA Notices.  Send the following HIPAA Notices:

    • HIPAA Portability Notices in accordance with applicable federal HIPAA guidelines set forth in 29 C.F.R. 2590.701 (as amended from time to time).
    • WageWorks’ standard HIPAA Rights Notice in accordance with DOL Reg. §§ 2590.701-3(c) and 2590.701-6(c).

b)    Women’s Health Care and Cancer Rights Act Notice.  Send WageWorks’ standard Women’s Health Care and Cancer Rights Act Notice following enrollment in the applicable Health Plan and annually thereafter as soon as reasonably possible after receiving from you the information necessary for WageWorks to complete the Notice.

c)    On-site Meetings.  Participate in benefits fairs.

d)    Customization Services.  Provide customization services for non-standard files and/or communications.  

e)    Carrier Remittance Services.  Remit premiums directly to carrier.

f)     Post-termination Transition Services.  Provide mutually agreed upon post-termination transition services.  WageWorks shall not be obligated to provide post-termination transition services if services are terminated due to your failure to pay amounts due. 

 

  IV.  DISCLAIMER 

Notwithstanding anything to the contrary, WageWorks shall not be responsible to receive or review claims for benefits under any Plan(s), or be liable for the payment of any claims for benefits under, or in connection with, any Plan(s).

  

   V.  DEFINITIONS 

"COBRA" means the Consolidated Omnibus Budget Reconciliation Act of 1985 and the regulations issued thereunder, as amended from time to time. 

"Continuant" means a Qualified Beneficiary who has elected COBRA and is currently covered. 

"Health Plan" means the group health plan(s) established and maintained by the Client, as identified by Client. 

"HIPAA" means the Health Insurance Portability and Accountability Act of 1996 and the regulations issued thereunder, as amended from time to time. 

“Notice” a notice required to be sent by applicable federal law. 

“Open Enrollment Period” means the period during which a Qualified Beneficiary may elect COBRA continuation coverage and enroll in or change coverage under a Plan. 

"Qualified Beneficiary" shall have the same meaning as 26 U.S.C. 4980B(g)(1).

 

[V. 3/19/15]