Your plan for better healthSM1
Search

Renewal Eligibility Verification Audits = REVA

Frequently Asked Questions


1. Is it necessary for my group to be audited each year?

2. How can I verify this with the North Carolina Department of Insurance?

3. What is the difference between an affidavit and a questionnaire?

4. I am the owner of my business. Do I also count myself when completing these forms?

5. My spouse and I work for the group but we do not take a salary. What kind of tax documents will I need to submit for my audit?

6. I am the owner and listed on the NC Unemployment Tax & Wage report. Will I need to submit other tax documentation?

7. I am the owner but I am not on the group plan; what documentation is required?

8. There are several part-time employees on my payroll and listed on my state tax report. What is required for those employees?

9. One of my employees has been on leave of absence for an accident he was involved in several months ago. How do I handle this situation as it pertains to the audit?

10. What do I do if I make a mistake on my affidavit or questionnaire?

11. I want to protect the privacy of myself and my employees. Am I allowed to cover or white-out income or social security numbers on any of the tax documents?

12. I am still concerned about the privacy of the documentation I submit. How can I be assured that the material I submit for my audit will not be misused or viewed by others at Blue Cross and Blue Shield?

13. I have 2 new employees that are still in their probationary period. What do I need to do for those employees?

14. If someone is at the end of their probationary period and wants to enroll on my group plan, how do I get an enrollment application and where do I send it?

15. What if some of my full-time employees do not want health coverage or they have coverage elsewhere?

16. I sent declination forms and ID cards for 3 of my employees not accepting coverage with my group last year. Do I need to send them again?

17. What are the types of health plans accepted as 'group' coverage?

18. When I became eligible for Medicare my dependent spouse was able to remain on the group policy as a 'sponsored dependent'. Is that still allowed?

19. I know there are participation guidelines. What does this mean?

20. How much of the audit is my agent responsible for?

21. Can I mail the audit to Blue Cross and Blue Shield?

22. Will I need to mail the original after it is faxed or emailed?

23. How do I know my tax documents aren't lying around on a fax server at Blue Cross and Blue Shield for anyone to view?

24. How will I know when my audit has been completed?

25. Can a questionnaire or affidavit be completed in pencil?

26. I received a pending cancellation letter. What does that mean?

27. Should I call to confirm receipt immediately after submitting?

28. How can I identify material faxed or emailed for my group?

29. What type of tax documents are needed for a 1 man Sole Proprietor group?

30. I have some general questions regarding my audit. Who should I call?



1. Is it necessary for my group to be audited each year?    top

Yes.

  • The North Carolina Department of Insurance (NCDOI) requires an annual verification of eligibility. This audit verifies all small groups covered on a 'group plan' are in compliance with the rules and regulations set forth by Small Group Reform.
  • While Small Group Reform is a federal law each state must interpret and enforce these laws accordingly.
  • All North Carolina carriers must conduct an annual audit but the methods used vary from carrier to carrier.
  • Determination of the audit methods are left to each carrier and presented to the NCDOI for approval.


2. How can I verify this with the North Carolina Department of Insurance?    top

  • You may contact the NCDOI by telephone (800) 546-5664.
  • You may also review the statues of Small Group Reform by going to the NC General Assembly website and click on then click on "Chapter § 58-50-110. Definitions." Or you can go directly to the chapter.


3. What is the difference between an affidavit and a questionnaire?    top

  • Affidavit - Form for groups with 6 or more subscribers enrolled on the group health plan. This form must be fully completed, signed and dated by an authorized group executive. **Questions 3 - 6 must equal question 2.
  • Questionnaire - Form for groups with 5 or less subscribers enrolled on the group health plan. This form must also be fully completed, signed and dated by an authorized group executive. **You must return current tax documentation for each employee enrolled on the group plan and proof of other coverage for each full-time employee that is declining coverage with your group when you receive this questionnaire.


4. I am the owner of my business. Do I also count myself when completing these forms?    top

  • If you own the company and work a minimum of 30 or more hours each week on an annual basis you would include yourself in the number of full-time employees.


5. My spouse and I work for the group but we do not take a salary. What kind of tax documents will I need to submit for my audit?    top

  • You need to submit year end tax returns for the business to show your ownership. If you have filed an extension, you need to submit a copy of the extension request along with the prior year tax return.
  • If your spouse is not an owner you need to submit a copy of your joint (or your spouse's individual) IRS 1040. If there is any income reported on line 7, we require W-2's to support all income reported. This ensures there is no income outside your covered business. Submit a letter on company letterhead to attest to the full-time employment status of both you and your spouse.


6. I am the owner and listed on the NC Unemployment Tax & Wage report. Will I need to submit other tax documentation?    top

  • We need a copy of the NC Unemployment Tax & Wage report for your group if all employees listed shows sufficient income to support a minimum work week of 30 hours at the required minimum wage for the entire quarter reported.
  • If income does not support full-time status please submit a letter of explanation along with your audit material. **Additional tax documentation may be required.


7. I am the owner but I am not on the group plan; what documentation is required?    top

  • If you are employed in a full-time capacity as stated above we will only require proof of other coverage. Tax documentation would not be required.


8. There are several part-time employees on my payroll and listed on my state tax report. What is required for those employees?    top

  • We do not need any documentation for part-time, temporary or seasonal employees but do we need you to indicate each employee's employment status beside their name on the state tax & wage report. This prevents us sending you a 'missing information' letter asking for this information.


9. One of my employees has been on leave of absence for an accident he was involved in several months ago. How do I handle this situation as it pertains to the audit?    top

  • Indicate leave of absence by marking 'AE' beside his name.
  • If this employee has not been out of work more than 60 days, submit a letter with your audit material providing the date leave began and when the individual is expected to return to full-time employment.
  • If this employee has been out of work for more than 60 days it is time to have him either cancel his coverage or apply for state continuation/cobra. Employment status changes, whether from full-time to part-time or full-time to leave of absence or termination, you must offer state continuation and it must be accepted or rejected at the end of 60 days from the first day of the change. If not accepted the employee coverage must be cancelled.


10. What do I do if I make a mistake on my affidavit or questionnaire?    top

  • Submit a corrected form along with a letter explaining the difference between the first one and the second one submitted. This letter must be signed and dated by the same person that signed the form.


11. I want to protect the privacy of myself and my employees. Am I allowed to cover or white-out income or social security numbers on any of the tax documents?    top

  • For verification purposes we can not accept altered tax documents. We can however, accept the last 4 digits of the social security numbers. Again, all documentation is used for verification purposes only.


12. I am still concerned about the privacy of the documentation I submit. How can I be assured that the material I submit for my audit will not be misused or viewed by others at Blue Cross and Blue Shield?    top

  • Your audit material is viewed only by the 3 processors in the REVA department. After review all pertinent material will go into your group file where it is locked away in our Business Library. Your file is only reviewed by the person or persons that assist in maintenance of your group policy and this requires a signature.


13. I have 2 new employees that are still in their probationary period. What do I need to do for those employees?    top

  • Provide the date of hire for each of them.
  • If either of them is at the end of their probationary period we need proof of other coverage or a fully completed enrollment application along with a copy of their W-4 if not listed on the state tax & wage report.


14. If someone is at the end of their probationary period and wants to enroll on my group plan, how do I get an enrollment application and where do I send it?    top

  • Contact your agent for a copy of the enrollment application or go to www.bcbsnc.com, on the internet to obtain administrative forms.
  • Enrollment applications can be forwarded to your agent for submission to BCBSNC or you can send them in with your bill.
  • If you are currently in audit and need to send an enrollment application we request you send REVA a copy also. Enrollment applications are processed in another department and we have no access to their fax server or email as they have no access to ours.


15. What if some of my full-time employees do not want health coverage or they have coverage elsewhere?    top

  • We require either fully completed declination of coverage forms or copies of current carrier ID cards. *We do not need both.
  • Declination of coverage forms must be the BCBSNC form and can be obtained by requesting a copy from your agent or our web site, www.bcbsnc.com
  • The declination of coverage form must be fully completed, signed and dated by the employee only.


16. I sent declination forms and ID cards for 3 of my employees not accepting coverage with my group last year. Do I need to send them again?    top

  • Yes
  • All audit material must be current. Declinations must be signed and dated within 90 days of submission.
  • ID cards from the year before could be cancelled now. In order to verify the health insurance for that individual is still active we will need to call the insurance carrier. This would considerably slow down processing of your audit.


17. What are the types of health plans accepted as 'group' coverage?    top

  • Health insurance plans accepted as 'group' coverage is Medicare, Medicaid, spouse's employer's health coverage, veteran's, etc.
  • Quite simply, group health coverage would be a plan that you would either pay only a percentage of or no money would be required from you to remain on the plan.
  • **Individual coverage is not accepted.**


18. When I became eligible for Medicare my dependent spouse was able to remain on the group policy as a 'sponsored dependent'. Is that still allowed?    top

  • Effective 4/1/07 this is no longer allowed. There are certain conditions under which a dependent that has been approved to remain as a sponsored dependent under the 'grandfathered clause'.
  • The conditions under which this is allowed (using the grandfathered clause) is as follows: If the enrollment took place prior to the change of 4/1/07; you must still be employed in a full-time capacity and you must provide current tax documentation to show your full-time status along with a copy of your Medicare card. Submit a statement regarding anyone on your group plan that is covered as a sponsored dependent when you submit audit material.


19. I know there are participation guidelines. What does this mean?    top

  • In order to control cost of health insurance, as well as provide much needed health care for our communities in North Carolina, we encourage as many employees as possible to enroll with their employer's health plan. We have established participation guidelines for our small groups as follows:
  • All groups with 5 or less full-time employees must maintain 100% group coverage. This does not mean all must be covered on your group policy but it does mean they must be covered with 'group health' if not covered by your group.
  • Groups with 6 and above full-time employees are required to have 75% of net total. This net total is derived by the following formula:
  • # gross total of full-time/eligible employees
    Subtract # Probationary period employees
    Subtract # Employees with other group coverage
Equals number of net eligible employees
Multiplied by 75% = percentage of employees needed to enroll **all % carried to the highest number
Ex: 23(gross) - 5(PP) - 7(other group) = 11(net) x 75% = 8.25 *you would need 9 enrolled on your group plan in order to meet the 75% participation.


20. How much of the audit is my agent responsible for?    top

  • Your agent is there to assist you with all areas pertaining to your group policy. It is however, your responsibility to ensure all audit materials are gathered and submitted to REVA by the deadline date stated. Your agent may assist you with questions regarding the material necessary for the audit and also in submitting it but the agent can not provide any of it without you.


21. Can I mail the audit to Blue Cross and Blue Shield?    top

  • We strongly advise against mailing it externally. This audit material is vital in maintaining continual coverage and could become lost in external mail. If it is lost neither you nor REVA has any way of tracing it. If we do not receive it, we are unable to give you credit and your group plan stands a good chance of being cancelled.
  • We encourage you to send it to your agent for submission to REVA or send it directly to REVA yourself.
  • You may fax the material to us at 919-765-4052 or scan and email to reva@bcbsnc.com
  • Keep a copy for your records.


22. Will I need to mail the original after it is faxed or emailed?    top

  • No. We accept the faxed or emailed copy of all of the documents.
  • Keep a copy of all that was faxed or emailed with the date and number of pages sent.
  • Keep fax confirmation if your fax server provides it.


23. How do I know my tax documents aren't lying around on a fax server at Blue Cross and Blue Shield for anyone to view?    top

  • Our fax server is connected directly to the REVA processors' computers and only we have access for retrieval.
  • Our REVA email goes to a mailbox that only we have access to also. There are 3 processors in the REVA department and we alternate the mail on a daily basis. It is then distributed evenly among the 3 of us for processing.


24. How will I know when my audit has been completed?    top

  • You will receive a letter of confirmation in the mail.
  • Your agent will receive an emailed copy of the confirmation letter and also a hard copy through mail.


25. Can a questionnaire or affidavit be completed in pencil?    top

  • No, these are legal documents and should be completed in ink.


26. I received a pending cancellation letter. What does that mean?    top

  • The pending cancellation letter is automated. It goes out on the day of deadline as a warning that we have not received all necessary audit material within a sufficient time period to complete the audit process prior to the deadline stated. If the pending cancellation letter is received and you have just submitted your audit material please allow us 2-3 days to process, and call to confirm if all materials were received.


27. Should I call to confirm receipt immediately after submitting?    top

  • No, normally it takes about 2-3 days for processing. If possible to wait the 2-3 days after submitting documentation, we may be able to provide a status report instead of just letting you know that information was received but not reviewed.


28. How can I identify material faxed or emailed for my group?    top

  • We must have the group number and group name on the cover page of all information submitted. Otherwise, we will be unable to match the material to your group.


29. What type of tax documents are needed for a 1 man Sole Proprietor group?    top

  • We need the Schedule C, E or F with 1040 and W-2's,
  • The income must show a net profit within the last two years and
  • Must show that the majority of the income is derived from the covered group.


30. I have some general questions regarding my audit. Who should I call?    top

  • You may contact your agent for assistance or you may contact REVA directly.
  • REVA is here to assist you and your agent with any questions you may have regarding your annual audit. Our phone number is (919)765-4052 for our local customers and 1(800)446-8053 for all others and our email address is reva@bcbsnc.com