Using the Enroll Application, Employers may sponsor benefit coverage for their employees at initial offering and renewal of coverage. Employers set the rules under which employees and their eligible dependents receive coverage, they set employee premium contribution as well as the dependent coverage and contributions. They select a reference plan which sets their costs. Employers can also offer dental coverage to their employees. The dental coverage plan year must be the same as the medical coverage plan year.

Self-service Registration

Employers are able to manage the points of contact for their group that have access to their employer account.

Employers have a homepage that initially guides them to populate their employer roster and establish benefit offerings. Once the sponsored benefits are finalized, employers are able to track the open enrollment activity of employees and see current employee enrollments as well as their monthly invoice. All past invoices are also accessible in the employer’s account.

Employers are able to select a broker, terminate a broker assignment, and change a broker assignment. *on the small group marketplace only employers have this permission.

Employee Roster

Employers &emdash; or brokers or general agencies, acting on their behalf &emdash; can manage their roster of eligible employees: 1) one at a time through the user interface, or 2) through bulk upload of a spreadsheet template. Bulk upload via spreadsheet can be used to add newly eligible employees, update information for existing roster employees, or terminate eligibility.

Employers are able to add eligible employees and new hires to their employee roster one at a time or by uploading using an Excel (CSV) template. Employers are able to update the demographic information for their employees and add dependents of employees onto the employee roster. Employers are able to terminate employees on the roster.

Benefit Package Design

Employers are able to setup their annual plan year including selecting:

  1. Plan year effective date
  2. Plan offering model
  3. Employer contributions
  4. Family member eligibility
  5. New hire eligibility rule.

Employers are provided with cost modelling during the plan shopping that shows costs from both the employer’s perspective as well as the employee perspective.

Using the Enroll Application, Employers may sponsor benefits for their employees. Employers are required to offer health plans at a minimum and may optionally add dental coverage to with different contribution amounts. When employers are establishing their benefits offerings they are able to:

  1. Set the coverage start date (the system has a range for this for the dates available based on the date of application)
  2. Fill in the number of full-time, part-time, and Medicare secondary payer employees in their small group
  3. Set up multiple benefit packages. Employers are allowed to set up multiple benefit packages with different rules, plan offerings, and contributions for a single plan year.
    • This is often done for groups that have different offerings for full-time and part-time employees or have different office locations.
  4. Establish the new hire coverage effective date (options – 1st of the month following or coinciding with date of hire, 1st of the month following 30 days, 1st of the month following 60 days)
  5. Choose what dependent groups (if any) to offer coverage.
  6. Set the premium contributions for employees (must be at least 50% except during annual open enrollment period) and set the premium contribution for covered dependent groups (employer premium contribution can differ between dependent groups)
  7. Set employee choice offerings. On DC Health Link groups can offer all plans from a single carrier, all plan from a single metal level from all participating carriers, or a single plan.
  8. Select a reference plan. This plan set the employer contribution at a fixed dollar amount for all employees and covered dependents.
  9. Add dental coverage.
    Dental coverage is offered in a similar manner, except that we offer full choice and no contribution is required of the employer.

Plan Choice

Employers may compare and select from among three different options for which health plans to offer to their employees:

  1. All plans from one metal level (“Employer choice”)
  2. All plans from one health insurance company (“Employee choice”)
  3. One plan only (“Single plan”)

The system allows employers to compare and select from among four different options for which dental plans (if any) to offer to their employees:

  1. One plan only (“Single plan selection”)
  2. All plans from one dental insurance company (“Employer choice”)
  3. All dental plans from all dental insurance companies (“Full menu”)
  4. Any combination of available dental plans

Employees are able to enroll in dental coverage without enrolling in medical coverage.

Employer Contribution

The system supports employer contributions as a percentage of a selected reference (or benchmark) plan chosen by the employer. For our congressional customers, we support a hybrid percentage/fixed dollar amount contribution model, based on a fixed percentage, with not-to-exceed fixed dollar amount caps, which vary based on the number of dependents.

The Enroll Application is designed to enable new contribution models as plug-and-play extensions to the existing system.

Employers can setup different contributions for medical plans and dental plans, different contributions by family member relationship type (i.e. employee, spouse, domestic partner, child).

Minimum contribution requirements can be applied to individual contribution options - it is currently configured to only require minimum contribution for the employee medical coverage. Other models could be adapted with custom development for the Health Connector.

Application Eligibility

Minimum Contribution

January 1 Effective Date Exemptions

Enrollment Eligibility

Minimum Participation

Non-Owner Participation

Premium Invoice and Online Payment

Renewal

Renewal employers can change any of the offerings above EXCEPT for the coverage start date. In order for a group to be considered a renewal they must complete a 12 month plan year on DC Health Link and remain in continuous coverage.

When employer renewal becomes available to the employer (currently 90 days in advance of the end of the current plan year), the system generates a draft renewal plan year in the employer’s account that is prepopulated with the same options the employer offered in the previous plan year, including:

  1. Plan offering model (i.e. “horizontal option,” “vertical option,” or “single plan option”),
  2. Employer contribution percentages,
  3. Employer contribution reference plan (with plan mapping, as appropriate), and
  4. Employee eligibility rule.

Employer can elect to keep the prepopulated renewal plan year or make changes.

If an employer does not finalize the draft renewal plan year by the employer application deadline, the renewal plan year is finalized on behalf of the employer.

When an employer finalizes its renewal plan year and the employee open enrollment period begins, an auto-renewal is generated for each enrolled employee in the employee’s portal based on the annual plan mapping and reflecting the employer’s new contributions. If an employer changes plan offerings in a way that prohibits an employee from being auto-renewed (generally, this occurs when an employer changes from all plans from one carrier to all plans from a different carrier), no auto-renewal policy will be generated for the employee and the employee (or broker, on behalf of the employee) would need to make an active plan selection during open enrollment in order to be enrolled in the upcoming plan year.

Employer renewal process deadlines and time periods are fully configurable, including: renewal start date, minimum and maximum open enrollment length, and open enrollment start and end days of month.

COBRA

Employers newly joining the Exchange may designate former employees who are in COBRA status. Health Connector Employers with employees who terminate employment may transition into COBRA status.

From the Employer perspective, a terminated employee continues to appear on the roster in COBRA status. COBRA-status former employees remain assigned to a benefit package along with active employees, with access to that package’s respective plan offerings. Similar to current employees, COBRA-status former employees are auto-renewed into prospective plans under the employer’s enrollment renewal process.

Employer premium contributions are overridden, with 100% of the premium responsibility assigned to the COBRA-status employees.

Former employees who are in COBRA status may continue to use the Health Connector to access and manage coverage, including plan selection during Employer open enrollment and special enrollment periods due to qualifying life events.

COBRA administrative deadlines and time periods are configurable within the system.

Online Case Management

Many operations available only through case management interfaces on other systems are accessible as self-service functionality in the Enroll Application. Examples include:

  1. Add newly eligible employees
  2. Terminate employees who are no longer eligible
  3. Rehire previously terminated employees who are newly eligible again
  4. Initiate COBRA/continuation coverage for terminated employees