An Important Message for NC Health Benefit Representatives

April 2024

NCFlex Vendor Contacts for You

Each of our vendors (Voya, EyeMed, MetLife, Allstate, P&A, The Standard and Selman) has a team or an individual available to assist benefit representatives and payroll contacts on complicated employee issues or plan questions. You can find these contacts in our Admin Manual starting on page 11.

While the NCFlex team is also here to assist, you may have a situation such as an employee with questions about how an out-of-network dental procedure was paid. You can reach out to Mary Faile from MetLife who can help research and better explain the claim. Or, you may have an employee whose FSA card was declined at the terminal in the pharmacy, but it is not expired or lacking funds. Reach out to Cindy with P&A and learn why the card may have been declined.

Please do not share these contacts with employees. These contacts are for you to escalate issues when needed. Employees can utilize the vendor contact information located on our website under each benefit tile or in the Enrollment Guide.

QLEs and Supporting Documentation

As a benefits representative, you may be responsible for reviewing and approving Qualifying Life Event (QLE) documentation when changes are made to NCFlex benefits in the enrollment platform.

For life events that fall into the "Loss of Other Coverage" or "Now Eligible for Other Coverage" categories, be sure documentation supports that the coverage lost or gained coordinates with the coverage being removed or added. For example, an employee who lost dental coverage should not be allowed to add cancer coverage.

Note that further review may be needed for someone gaining a Medicare Advantage plan. At first glance, it may not seem that the employee is gaining dental or vision, but many Medicare Advantage plans also include dental and vision. If you see that the employee has gained a Medicare Advantage plan, either request coverage information from the employee or research online, based on the name of the plan to see if dental and vision are covered. If you are still unsure whether to approve or deny the QLE, reach out to NCFlex at ncflex@nc.gov.

Employees on LOA and NCFlex Premiums

If you have an employee on a leave of absence (LOA) and benefit premiums are not being deducted or collected, please share with that employee how to pay premiums while they are out.

Things to consider, some of which can be reviewed in the Admin Manual:

• Communicate current benefit rates with employees.
• Some vendors differentiate payment collection procedures for employees on leave versus those who are separated.
• Some benefits, such as Term Life, have a specified time in which an employee must port (move from the active group plan to a policy directly with the vendor) coverage before coverage is no longer valid.
• You may have a standard letter with LOA information to be shared with employees, available through your employer or payroll unit. If you are unsure if you have a standard letter or would like an example, reach out to us at ncflex@nc.gov.

Ensure an employee’s benefits are canceled in the enrollment system before providing guidance on paying premiums. Vendors must be made aware of the reasons for payments. Cancellation of unpaid benefits should be done ASAP, to avoid retroactive cancellations through exceptions that can cause a reversal of claims.

Employees can choose if they wish to keep their NCFlex benefits while on leave of absence. Whether they pay while on LOA or not, they can re-enroll when/if they are reinstated. The HCFSA is the only benefit the employee must re-enroll in. The others are a choice, but depending on if premiums were paid while out, EOI may be required.

You can find information on this topic in our Admin Manual starting on page 14. Reach out to us at ncflex@nc.gov if you have questions.

Upcoming NCFlex Webinar Opportunities

The NCFlex Voluntary Disability Plan through the Standard is offered to non-university employees*. This plan is a supplement to the TSERS Disability Income Plan of North Carolina (DIPNC). All employees are invited to join us to learn more about this benefit whether they're enrolled in the plan or may consider enrolling in the future.

We'll discuss:

• Enrollment
• How the plan works
• Pre-existing conditions
• Filing claims
• Reinstatement following a leave of absence
• How the plan coordinates with the DIPNC and more.

Aspects of the presentation will highlight the administration of the plan, so it's a great opportunity for HBRs to brush up on their knowledge. Register with the buttons above or through our webinars page.

*University employees are offered a disability plan through their employer.

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