Plan Administrator FAQs

How long does it take to enroll an employee and to issue identification cards once the application is received?

If the application is complete, the employee will be enrolled and an ID card mailed to the employee's address within two to three weeks from receipt of the application. If the application is incomplete, enrollment will be delayed until we receive the necessary information.

What happens if the employee has not received his/her identification card prior to using health care services?

The "yellow employee copy" of the Group Application Form may be used as a temporary identification card until he/she receives the ID card. Keep the "pink employer" copy of the form for your files. Providers can also call the Prevea360 Customer Care Center to verify the coverage date of the employee/dependent.

As an employer, what can I do to help avoid enrollment delays for my employees?

Try to review each application to see if it is complete before sending it to Prevea360. Please pay special attention to the following areas:

  • Date(s) of hire
  • Social security number(s)
  • Date(s) of birth
  • Primary care provider(s) election (Not required for POS Plans)
  • Signature and date
  • Phone number
Remember, applications that are not signed or dated will be returned to the employee. This may delay the application unnecessarily, so please double-check this section before sending applications to us.

What is a Special Enrollment or Qualifying Event?

A special enrollment or qualifying event is an event that allows an employee to enroll in the insurance plan after having initially waived the coverage, or allows an employee to add a spouse or dependent(s) to his/her plan. Qualifying events are sometimes referred to as "life events" or "family status changes." Please visit prevea360.com/specialenrollment for more information.

Who is eligible to enroll when a "loss of other coverage" event occurs?

When a loss of other coverage occurs, only the employee and/or dependents who were covered by this other group plan immediately prior to the termination of the coverage are eligible to apply for coverage by Prevea360. The employee may not add any dependents who were not previously covered under the prior health plan.

How do I terminate coverage for an employee?

If you need to terminate an employee's coverage with Prevea360, you may:

  • Mail or fax a memo to the Enrollment Department with the employee's name, social security number and date of termination.
  • Call your Prevea360 Enrollment Representative to verbally terminate coverage. A written confirmation of the phone call will be mailed to you as a record of the phone call.
  • Make a note on the monthly billing statement.
  • Have the employee complete a Group Application Form and send it to our Enrollment Department. However, Prevea360 does not require this form to terminate an employee's coverage.

How is a verbal termination handled by Prevea360?

You may call the Enrollment & Billing Department directly to terminate coverage for an employee and/or dependents. The Enrollment & Billing Department will take down the information over the phone and process the changes If you reconcile your bill each month (as opposed to paying as billed), please make sure to note the termination on your billing reconciliation form.

Does Prevea360 allow retroactive terminations?

Prevea360 will refund or adjust premiums for retroactive terminations for up to three months. The month the request for retroactive termination is received is counted as one month.

When should changes be received by Prevea360 in order to have them noted on the next billing statement?

Invoices are prepared on the 7th of the month and mailed on the 10th (or the business day following). Changes received by the 1st of the month will be reflected on that month’s invoice.

For example: if changes are received by February 1st, they will be noted on the March bill, which is mailed on approximately February 10th.

As an employer, how much do I need to know about group continuation?

As the employer, you are responsible for notifying your employees and their dependents in writing of their rights to COBRA and Wisconsin continuation coverage. Therefore, you must be familiar with which events are qualifying events for group continuation to be offered to an employee or dependent. In addition, if your employee or dependent chooses to continue coverage, you need written documentation of their decision to continue. Therefore, you need to know the time guidelines that an employee has to elect group continuation. Finally, you are responsible for collecting the monthly premium payments from the employee or dependent and then making payment to Prevea360. Again, you will need to know the guidelines regarding when payments can be required from the employee or dependent and when a person can be terminated for nonpayment of premium.

Whose responsibility is it to notify the employee or dependent when the group continuation coverage will end and their options after it ends?

Prevea360 will notify the employee/spouse/dependent by sending a letter 60 days prior to the end of their group continuation coverage. The letter states when the coverage will end and the options for purchasing conversion health insurance available to the employee/spouse/dependent through Prevea360. You can forward any questions regarding plan options after group continuation to the Prevea360 Customer Care Center.

If, as an employer, we have questions concerning the Medicare Eligibility of our employees, who should we talk to?

Please call the Prevea360 Medicare Analyst at 608.827.4189, or toll free at 800.356.7344, extension 4189. You may also be able to determine answers through the contact of your Marketing Account Manager.

What if I still have questions?

Prevea360’s Customer Care Center is available Monday through Thursday, from 7:30 a.m. to 5:00 p.m., and Friday, 8:00 a.m. to 4:30 p.m., to answer your questions. Just call 877.230.7555. If you prefer, you may also call your Prevea360 Account Manager.

Billing FAQs

When can I expect my first Prevea360 Health Plan invoice?

You will receive your first Monthly Premium Billing Invoice on or around the 20th of the month of your group’s effective date.

What is included in the first invoice?

This invoice will represent premium for your group’s first two months on the plan, and it will include a discrepancy report to reconcile your initial binder payment.

What happens if I make changes to my plan after submitting my binder payment?

Please note that any membership adjustments received on or after the 15th of the initial month of your coverage will not be reflected on your first Monthly Premium Billing Invoice. These changes will be reconciled on the next month’s invoice.

What is the billing cycle after the first month’s invoice?

Regular monthly Premium Billing Invoices are prepared approximately 45 days in advance of their due date and are mailed on the 10th of the month prior to the due date. For example, invoices for October premium are prepared at the end of August, mailed on September 10, and due on September 30.

Who can I contact with questions about billing?

For questions about your Premium Billing Invoice, please contact Prevea360's Enrollment & Billing Department at 877.231.3221.