All Group Enrollment Forms, Change Requests, and ...

[Pages:3]All Group Enrollment Forms, Change Requests, and Adjustment Reports received by Lincoln must have certain information to accurately process the request. Providing all information initially allows the processing to be made timely and ensures a seamless client experience.

This Required Information Guide should be used to ensure all information is provided initially and based on contractual agreements with Lincoln.

Required Information

Guide

Coverage Election/ Benefit Election: The coverage type and amount or tier* a member is requesting.

o Why? Required for all coverages when there are multiple options available.

o Example: Class may be associated with a Taxable or a Non-Taxable Benefit in which the member is allowed to elect or the member can elect a flat benefit or an incremental benefit.

Billing Location and/or Sort Group: The Billing Location 'BL' (account number /group location) or Sort Group in which a member is to be enrolled.

o Why? Required to ensure the correct group account is billed (and sorted if applicable). If not provided, it may cause accounting/payroll and privacy issues because the member is improperly enrolled in the incorrect Billing Location.

Plan Number and/or Class Number: The plan or class number as defined in the group's contract describing the plan type or classification of employee.

o Why? Required for all coverages with multiple plan or class options.

o Example: Plan 1 of a Basic Life policy allows Part-Time employees and has 2 Classes within that Plan; Class 1 for Full-Time employees and Class 2 for Part-Time employees. Plan 2 of the same Basic Life policy does not allow Part Time Employees and has one class; defined as: Class 3 for Full-Time Managers.

Note: The plan and class number may be the same or the Employer Group may only have one plan number with multiple classes.

Salary and Salary Mode: The member's earnings and the mode on which it is based (annually, monthly, semi-monthly, bi-weekly, weekly, hourly, etc.).

o Why? Required for Disability and/or Life when the benefit is salary-based units or is flat incremental units based with a max percent of salary.

Date of Hire and/or Date of Rehire**: The date the member was hired, rehired, or first became eligible for coverage.

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o Why? Required to verify eligibility and to ensure the member is enrolled with the correct effective date for accurate billing.

Qualifying Event Date (QE): The date a person marries, or if applicable enters a domestic partnership, the date of birth and/or the date of adoption or acquisition of the eligible dependent(s). o Why? Required to ensure a member is not enrolled back to their original effective date and/or the member or dependents are not enrolled as late entrants.

Occupation: The occupation of the enrolling member as defined by the group. o Why? . It may be needed for claims purposes to determine the appropriate recovery time for a specific disability based on the type of labor the employee performs. This may also be required to determine the class an employee should be enrolled.

Member has an eligible dependent: Dependent can be a spouse, domestic partner, and/or a child. Dependent Life: LFG only needs to know if the member has a spouse, domestic partner, and/or dependent(s) for Life insurance coverage. No date of birth or name is needed when enrolling a dependent's life coverage.

o Why? Required when the group has a 100% employer-paid Dependent Life. Voluntary Spouse or Domestic Partner Life: The spouse or domestic partner's date of birth.

o Why? Required when rates and/or benefit reductions are based on the Spouse or Domestic Partner's Age.

Dental/Vision: Dental or Vision information is tracked and each eligible dependent's name and date of birth is required.

o Why? Required to process claims correctly.

Hours Worked: The average hours a member works each week. o Why? Required to determine eligibility and verify the member is working qualified hours as defined by the group's contractual eligibility. Also used to determine the benefit amount and premium if the benefit is salary-based. o Example: Member is an hourly employee and the benefit is salary based. o

Termination Date: The date the employee requested to terminate an employee-paid coverage or the last day of employment. o Why? Required to ensure the group is no longer billed for the coverage and proper processing of claims.

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 Smoker Status: The employee's and/or spouse or Domestic Partner's tobacco use within the last 12 months. o Why? Required when rates are based on tobacco usage to ensure the correct premium is calculated .

Sign Date and/or Signature: The employee signature and/or the date the member elected coverage. o Why? Required for confirmation of election into employee-paid coverage(s) and the authorization of payroll deductions, along with determining eligibility and late entrant status.

Member's Address: Employee's mailing address. o Why? Required to send correspondence to employee such as dental cards, named certificates, decision letters, etc.

Social Security Number: Employee's full Social Security Number. o Why? Required for employee identification and to ensure proper processing of claims.

Date of Birth: The employee's date of birth (MM-DD-YYYY). o Why? Required to verify eligibility due to Guarantee Issue, Age Reductions, and to calculate correct Premium.

For any questions, please contact Client Services for assistance at Phone: 800-423-2765

Email: ClientServices@

*Tier is for Dental and/or Vision coverage. Example: Dental/Vision tier 4 coverage can elect 1-Emp Only, 2-Emp+Spouse, 3-Emp+Child/ren, or 4-Family.* **Lincoln requires the date of hire and/or the date the member became eligible for the coverage based on the

contractual eligibility. Example: Contractual eligibility states that a member must work 30 hours each week to enroll in coverages, but the member didn't initially work 30 hours a week. LFG would need the date of hire and the date for which the

employee began working the required 30 hours each week.**

Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates. Affiliates are separately responsible for their own financial and contractual obligations.

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