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Here are answers to some of the most frequently asked questions from Employers about FirstCarolinaCare Insurance Company (FCC):
- When should a new employee fill out the enrollment materials for FCC benefits?
- What needs to be completed on the Enrollment Form?
- How is the coverage effective date determined?
- Is there a form to fill out if the employee declines health benefits?
- When can an employee drop coverage or change his/her dependents?
- What are the procedures for terminating employee coverage?
- What are the procedures for notifying FCC of a change in employee status, such as a reduction of hours?
- How does an employee add or remove dependents from their health benefit?
- How does an employee notify FCC of an address or name change?
- What changes can be made during the annual enrollment period?
- What is meant by the term “late enrollee”?
- What is a pre-existing condition?
- What services require pre-certification?
- How does an employee check the status of a medical or vision claim?
When should a new employee fill out the enrollment materials for FCC benefits?
It is best to have the employee complete all of the enrollment materials during the employee’s initial orientation period. Because there is a limited amount of time available to complete the enrollment process, it is best to get everything completed and signed right away. Once the forms are completed they may be sent directly to us.
What needs to be completed on the Enrollment Form?
The information needed is found in Section I 
of the Employer Handbook.
Included in that section are complete instructions as well as sample forms that have been completed.
How is the coverage effective date determined?
Each employer has determined a waiting period that will apply to new employees, employees who have a change in status and rehires. These guidelines will be used to determine the effective date. The hire date and the signature date are also extremely important in calculating the effective date for the employee.
Using your company’s guidelines, and starting with the date of hire, calculate the first date that the employee would be eligible to start his or her health insurance benefits. This date is called the eligibility date. If the employee fills out and signs the Enrollment Form prior to or on that date, the eligibility date becomes the date that his health insurance will go into effect (the effective date). If the employee completes and signs his form after the eligibility date, but within 31 days after it, the insurance will go into effect the first day of the following month. If the employee waits longer than 31 days after the eligibility date to complete and sign the form, (s)he may not enroll until the next special enrollment period and pre-existing conditions may apply.
Is there a form to fill out if the employee declines health benefits?
Yes, the employee must fill out the Waiver form if (s)he does not wish to enroll for FCCIC health benefits. Be sure that the employee has checked the reason for declining the health benefits. The employee must sign and date the form. Also, please include the name of your company on the form and the employees effective date.
When can an employee drop coverage or change his/her dependents?
Once the employee is enrolled, he may only make changes during a special enrollment period. Special enrollment periods are of two types.
- Annual Special Enrollment Period: Each year at the time of your contract renewal with FCCIC, there is a period of time (for which your company will set the dates) during which subscribers can make changes to their number of dependents, add on insurance, drop insurance, etc. These changes must be made and signed during that window of time. The employee will use an enrollment form to make the changes. Late enrollee status may apply to members who add the insurance during this time.
- Personal Special Enrollment Period: During the year, there may be changes in the subscriber’s family or employment status. These are called Qualifying Events and allow the subscriber a 31-day window to change the employee’s insurance. Examples include (but are not limited to): marriage, birth or adoption of a child, divorce, death of dependent, employment change resulting in the addition or loss of group coverage for a dependent. The form to make changes must be completed and signed within 31 days of the qualifying event. Documentation is usually required to verify the actual date of the event.
What are the procedures for terminating employee coverage?
Detailed instructions on Termination of Employee Coverage are outlined in Section II of the Employer Handbook.
What are the procedures for notifying FCC of a change in employee status, such as a reduction of hours?
Section III of the Employer Handbook outlines in detail the procedures for:
- Enrolling and employee who becomes eligible due to a change in hours
- Procedure to waive coverage
How does an employee add or remove dependents from their health benefit plan?
Section IV of the Employer Handbook outlines in detail the procedures for:
- ADD dependent(s) at the time of a Qualifying Event
- ADD dependent(s) during an Annual Enrollment period
- DROP dependent(s) at the time of a Qualifying Event
- DROP dependent(s) during an annual Enrollment period
How does an employee notify FCC of an address or name change?
An employee can update their personal information in two ways as outlined below:
Using the Enrollment Form
- Select “Other” for the Reason Completing the Form
- Select Reason if available as a choice; also write in change in the appropriate area
- Fill out employee information in the top section of the form
- Sign and date form and return to FCC
Using the Name, Address, and Telephone Change form:
- Fill out all sections of the form, including name of the employer
- Be sure that the employee signs and dates the form, then return to FCC
Both forms are available for download in the forms section of this site.
What changes can be made during the annual enrollment period?
At this time the employee can add or drop coverage for himself and/or any qualified dependents that the employee may have without having a qualifying event. To see sample forms please refer to Section VI of the Employer Handbook.
What is meant by the term “late enrollee”?
A late enrollee is a person for whom coverage is requested other than during:
- The first period in which the person is eligible to enroll under this plan; or
- A special enrollment period, when applicable
Any person enrolling for coverage during the annual enrollment period will be considered to be a late enrollee and may have a pre-existing condition waiting period of 18 months applied. Any valid creditable coverage that existed prior to the enrollment will be considered in waiving or reducing the pre-existing condition time period. This will be determined by examination of the Certificate of Creditable Coverage that the employee presents to us.
What is a pre-existing condition?
A pre-existing condition is a physical or mental condition for which medical advice, diagnosis, care, or treatment was received or recommended within 6 months before the enrollment date. Neither genetic information without a diagnosis nor pregnancy will be treated as a pre-existing condition.
What services require pre-certification?
How does an employee check the status of a medical or vision claim?
When a member has a question about how a medical/vision claim was processed, please direct them to call 1-800-811-3298. Be sure to listen to the prompts for Customer Service. A customer service representative will be able to help the member answer any question concerning insurance payments, copays, coinsurance, deductibles, and denials. Please remember that vision coverage only applies if your group purchased the vision rider.
What are the procedures for submitting a claim for reimbursement for medical/vision services or prescriptions?
Medical Services
When a member receives services from a provider who does not file insurance claims, the member can submit a claim for reimbursement by providing the following information on a Claim Form, following the steps below.
To file the claim, the member must:
- Use a Member Reimbursement Claim Form
- Include an itemized receipt/bill from the provider. Ask the member to check to be sure that the receipt/bill includes the date of service, diagnosis code, procedure code, charge for each procedure, the provider’s address and tax identification number. The required information is usually found on the “super bill” that the member receives at the time of checkout at the provider’s office.
- Mail the form and receipt/bill to:
FirstCarolinaCare Insurance Company, Inc.
42 Memorial Drive
Pinehurst, NC 28374
Attn: Claims
OR;
- FAX the form and receipt/bill to (910) 715-8101 Attn: Claims
- Call your Account Manager if you have any questions or problems with the procedures described.