Frequently Asked Questions:

How do I complete an application?
Click here to download complete instructions. 

What is open enrollment? 
Open enrollment is an annual event in which you have the option to make changes to your insurance benefits without penalty. Open enrollment is the entire month before your company’s renewal date. For example, if your company is renewing its benefit plan on December 1, you have the entire month of November to make changes if available. Your Employer will distribute literature explaining the dates and perhaps a time to learn about new offerings available to you. If you have not turned in your signed applications within the allotted time frame, the terms of your previous coverage will remain in place.

What is an explanation of benefits (EOB)?
An EOB is a document that states the benefits that are covered and paid for by the insurance company. An EOB is not an actual bill.  This form typically shows the  “Amount Charged”, which is the full amount the physician or facility has billed the insurance company.  The “Amount Allowed” is the negotiated rate between the provider and the insurance company.  “Provider Responsibility” is the amount written off by the provider as determined by the negotiated rate.  The ”Amount We Paid” is the amount the insurance company paid the provider.  An amount “Not Covered” would account for a service that is not covered by the insurance company and becomes the member’s responsibility to pay.  Deductibles, Coinsurance and Member Copays are also the responsibility of the member to pay. 

Please call us anytime for further explanation or clarification of your EOB or if the charges appear to be incorrect.  We will be glad to check and make sure your bills have been processed correctly.

What doctors are In-Network with my plan?
You can always contact our office to determine if a physician is in your Network, but you can also search for providers at the websites below: 

What is the difference between In-Network and Out-Of-Network physicians?
Managed care plans (HMOs and PPOs) work with physicians who have agreed to the insurance company’s fee schedule (how much the doctor will be paid for each procedure). The physicians who have made this agreement are In-Network, and the physicians who have not agreed are Out-Of-Network. Some insurance plans allow you to go to an Out-Of-Network physician, usually at a higher cost to you since the physician has not agreed to a fee schedule.   Other plans only allow you to see physicians in their network. Networks are constantly changing, so be sure to confirm the status of the physician you wish to see.  

What is a “Qualifying Event”? 
Examples of a qualifying event include marriage, divorce, birth of a newborn, and loss of insurance coverage. ALL changes based on a qualifying event must be made within 30 days of the event. There are few exceptions to this rule. For example, if you are married on April 5, you will have until May 5 to add your spouse onto your plan. If you fail to add your spouse to your health coverage in the 30-day period, you will not be able to do so until the group’s open enrollment period. Also, if you wish to add a newborn onto your policy, you will only have 30 days from the child’s date of birth to add them to your policy.

Questions Regarding COBRA and Georgia State Continuation

What is COBRA and Georgia State Continuation?
Both COBRA and Georgia State Continuation are provisions that allow former employees of a business to keep their group benefits after they leave employment.  With both COBRA and GA State Continuation, employees terminated for gross misconduct are NOT eligible for continuation.

COBRA – applies to employers with 20 or more full time employees, and it is a federally mandated benefit which allows former employees to keep their group benefits through their old employer.  In most situations, the former employee is eligible to keep their benefits for up to 18 months by paying the full amount of the premium (without the employer contribution) to a third party COBRA Administrator.  One exception is for spouses going through a divorce, who can be eligible to keep COBRA for up to 36 months.  

Typically the hardest part of COBRA continuation is establishing the continuation benefit.  Under the law, it may take up to 45 days for a former employee to receive their first contact from the COBRA administrator, and it may take up to 60 days for the former employee to submit their first premium payment.  

Georgia State Continuation – applies to employers with 19 or fewer employees, and it is a state mandated benefit which allows former employees to keep their group benefits through their old employer.  In most situations, the former employee is eligible to keep their benefits for up to 90 days by paying their former employer the full amount of their premium (without the employer contribution).  The former employee has 30 days from their date of termination to notify their former employer of their desire to elect Georgia State Continuation.  All premium payments are due to the employer before the employer’s premium notice is due.  

Recently, laws at both the federal and state levels have been passed that impact COBRA and Georgia State Continuation provisions allowing eligible persons to pay only 35% of their premium for specified periods of time.

Please contact our office for more details as conditions vary for each circumstance.

COBRA and COBRA Administration Regulations
New Cobra Regulations: http://www.dol.gov/ebsa/COBRA.html

Questions Regarding Health Savings Accounts

What is a Health Savings Account (HSA)?
A HSA is a tax-favored savings account combined with a qualifying high-deductible health plan. This coverage allows you to deposit tax-deductible funds into an account that can be used to cover medical costs. HSAs enable you to take control of your own health care decisions. The savings account is designed to pay for medical expenses and/or provide savings for the future. Money put into the account can be used either during the year or accumulated in the account. Allowable medical expenses are defined by the IRS, and are much broader than most insurance carriers (i.e. includes dental, vision).  Individuals can deduct dollars contributed to the HSA account from their gross income, resulting in tax-free medical dollars. The account is similar to an IRA account, but an HSA is used for qualified medical expenses.

Who is eligible for an HSA?
Any individual covered by a QUALIFIED high-deductible health plan is able to set up a Health Savings Account.

  • In addition, individuals cannot be:
    • Covered by a health plan that is not a qualified high-deductible plan
    • Claimed as a dependent on someone else’s tax return.
    • Entitled to Medicare benefits (age 65 or older)

How much can I contribute to my H.S.A. this year?

  • Maximum HSA Contribution: $3,050 for individual, $6,150 for families. This means that, for example, an individual might have a plan with an $1,200 deductible, and could contribute $3,050 into their H.S.A  That is almost three years’ worth of deductibles in one year!
  • Individuals age 55 and older qualify for the “Catch-Up” provision, in which they can make contributions in addition to the allowed $3,050 for an individual or $6,150 for families.  The “Catch-Up” limit is $1,000 for each qualifying individual.


What is the difference between In-Network and Out-Of-Network physicians?
Managed care plans (HMOs and PPOs) work with physicians who have agreed to the insurance company’s fee schedule (how much the doctor will be paid for each procedure). The physicians who have made this agreement are In-Network, and the physicians who have not agreed are Out-Of-Network. Some insurance plans allow you to go to an Out-Of-Network physician, usually at a higher cost to you since the physician has not agreed to a fee schedule, and other plans only allow you to see physicians in their network. Networks are constantly changing, so be sure you know the status of the physician you wish to see.  

Billing Questions

What happens to my bill when I terminate an employee?
If an employee’s termination from the group’s coverage is effective at the end of the month, that employee may still be on the following month’s bill. For example, if an employee is terminated effective March 31, that employee may still show up on the April bill. However, the group will receive a credit for the terminated employee on the May bill. Please do not adjust the bill to reflect that employee’s termination. The group must pay exactly what the bill shows, regardless of an employee termination, because the insurance carrier may not have received the termination notice until after the following month’s bill has been generated. If the group sends in payment without the premium for the terminated employee, it will show that the bill has not been paid in full. The insurance carrier will then send out a termination notification that the group’s premium was not paid in full and alert the group that they are in danger of being terminated. This is important because claims are not paid on terminated groups

How do I pay my group insurance bill if I’m late?

  • AAHPS – AAHPS does not have a drop box outside of their office. All group premiums are due by the 1st of each month and AAHPS gives them a 1 Month grace period to have that payment in. Payments must be in their office by 5 p.m. on the last day of the month. If it is the last day to have the payment in, payment can be hand delivered to their office before 5 p.m. or post marked by the last day of the grace period. AAHPS will not accept payments over the phone or by credit card. There are no exceptions to this rule.
  • BCBS – You must overnight a check for the premium amount in order that the group not be terminated for non-payment of premium. You must overnight the payment to the address below:


BCBS of GA/Bank of America
Lock Box Services 406750 6000 Feldwood Road College Park, GA 30349

They will then need to call 1-877-364-2003 the next morning to inform BCBS that the payment is on it’s way. They will need to provide the tracking number of the shipped package, the check number and the dollar amount of the check. This way BCBS will not terminate the group. Many times if the group has gone the entire month without paying their premium, they are likely on the “cancellation list” to be terminated. They must call this number to inform BCBS that payment has been sent. 

  • UHC – Payment options are as follows:
    • Pay by Phone: 1-888-842-4571
    • Pay Online: www.employereservices.com        
    • Overnight Mail: UHC-PRIME, Lockbox 10151, 555 N. Cumberland Ave, Ste. 307, Chicago, IL 60656