Ceridian Flow Charts

PreliminaryApplicationand Rates

Horizon Blue Cross Blue Shield of New Jersey

sends client demographic information, plan

information and rates to Ceridian 30 days

prior to the effective date.

Data Entry and Verification

Ceridian will enter andverify the information with the client

COBRA RATE

REPORT

Ceridian will produce a COBRA

Rate Report.

COBRA Qualifying Event

Notification Forms&

COBRARATE REPORT

Ceridian provides the client with a COBRA Employer User Guide including the information and web access instructions for

accessing their COBRA Rate Report, and schedules appointments to review procedures with clients.

Ceridian will produce a Rate Report which shows all of the plans and rates provided. Rates shown will be 100% rates without the 2% administrative fee.

Implementation

MonthlyInvoice

NextMonth’s Invoice

TerminationLetter

Max Coverage/ Conversion

Letter

Ceridian generates and sends

invoices approximately

10 days prior to premium due date.

A Welcome Letter is sent with the first bill to the

existing COBRA participant

outlining COBRA rights, obligations and procedures.

Ceridian generates and sends next month’s invoice even if payment

HAS NOT been received. Premiums for the current month will be flagged with an asterisk and additional language regarding the

grace period will be shown.

Termination Letters for non-payment, maximum coverage,

cancel by request are generated by Ceridian. For nonpayment, Ceridian waits 6 days after the grace period

ends to allow for the mail.

Ninety (90) days prior to COBRA expiration, Max Coverage /

Conversion Letters are sent by Ceridian directly to COBRA participants, if applicable.

Participant UpdateReport

Certificates of Creditable Coverage are sent by Ceridian at the time of termination of COBRA.

HIPAACertificate

of CreditableCoverage

ComplianceCeridian COBRAReviewProcess

Ceridian will handle and address any

written requests for reviews and make

required determinations.

Ceridian will adjudicate COBRA eligibility throughout duration of

the COBRA continuation coverage

Participant Update Report faxed to the client. Ceridian forwards to Horizon Blue Cross Blue Shield of New Jersey in electronic EDI 834 format.

TakeoverForm

The client completesand submits TakeoverNotices for each Existing COBRA participant. The client can complete and submit electronic form on Ceridian website; or complete and fax or mail a paper form to Ceridian COBRA; or send an electronic file in Ceridian’s file specifications to Ceridian.

The client submits informationabout all existing COBRA

participants including those who are waiting to elect.

Transfer of Existing COBRA Participants

General Notice of COBRA Rights and Obligations

New EmployeeAdded to Plan,

Rehired EmployeeAdded Back on Plan or

New Spouse Added to Plan

ArchiveProof

Of Mailing

The client sends information about newly covered employees and/or spouses to Ceridian within 90 days of the date coverage begins. Client can complete and submit the New Hire Notification Form on the Ceridian website; complete and mail or fax a paper form to Ceridian; or send a file in Ceridian’s file specifications.

Ceridianretains proof of compliance for a minimum of sevenyears. This includesa copy of what was sent and proof of mailing.

The client addsemployee and/orspouse to plan.

New Hire Notification

Form

Process NewHire Notification

Forms

Ceridian willprocess the data supplied by the client.

Send General Notice of COBRA

Rights and Obligations

Ceridian willsend the General Notice of COBRA Rights and Obligations to the newly covered employee and spouse (if applicable) at the last-known home address.

The client informs Ceridian of a Qualifying Event.Client can complete and submit electronic form on Ceridian website; or complete and fax or mail a paper form to Ceridian COBRA; or send an electronic file in Ceridian’s file specifications to Ceridian.

COBRA Notifications and Elections

Ceridian sends COBRA Notification

Letter and Election Form to Qualified Beneficiary(ies)

at last known home address within 14 days of receipt of

completeand accurate information

regardingQualifying Event.

Month

Ceridian adjudicatesthe 60-day election period based on the later of the date of the notice and the

date benefits terminate.

Is electionwithin 60-daygrace period?

Election is rejected.Ceridian returns

election unprocessed with aletter of explanation

to Qualified Beneficiary.

No

Qualified Beneficiaryelects coverage bypaper, IVR or WEB.

Election isprocessed.

First Invoiceis sent with

45-day grace period.

Client notifiescarriers to

cancel QualifiedBeneficiary(ies),

COBRANotification

Letter &Election

Form

Yes

COBRA Monthly Billing

MonthlyInvoice

NextMonth’s Invoice

TerminationLetter

Max Coverage/Conversion

Letter

Ceridian generates and sends invoices approximately

10 days prior to premium due date.

Termination Letters for non-payment, maximum coverage,

cancel by request are generated by Ceridian. For nonpayment, Ceridian waits 6 days after the

grace period ends to allow for the mail.

Ninety (90) days prior to COBRA expiration, Max Coverage /

Conversion Letters are sent by Ceridian directly to COBRA participants, if applicable.

Participant UpdateReport

Certificates of Creditable Coverage are sent by

Ceridian at the time of termination of COBRA.

HIPAACertificate

of CreditableCoverage

ComplianceCeridianReviewProcess

Ceridian will handle and address any

written requests for reviews and make

required determinations.

Ceridian will adjudicate COBRA eligibility throughout duration of the

COBRA continuation coverage

Ceridian generates and sends

next month’s invoice even if payment HAS NOT been received. Premiums for the

current month will be flagged with an asterisk and additional language

regarding the grace period will be shown.

Participant Update Report is faxed or mailed to the client. Ceridian forwards to Horizon Blue Cross Blue Shield of New Jersey in electronic EDI 834 format.

Financial Flow

COBRAPremium

Participant paysCOBRA premium

to Ceridian.

Is payment timelyand in full (or within safe harbor rules)?

Payment is rejected and returned to participant.

Payment is processed and

applied toparticipant’s record.

ParticipantUpdateReport

If this is the first payment after an election, a Participant Update Report is faxed to the client. The client forwards to non-Horizon Blue Cross Blue Shield of

New Jersey carriers for additions of new elections with payments and

cancellations. Ceridian provides to Horizon Blue Cross Blue Shield of New Jersey on weekly basis in electronic EDI

834 format.

Premiumsare collectedthroughout

the month from allparticipants.

Premiums disbursedwithin 10 business days following period reported.

Yes

No

Standard procedure is to disburse full premiums only to the client. Partial

payments that meet safe harbor rules will not be disbursed until the full

premium is collected. The client is reimbursed for premiums previously

paid to the carriers.

Renewals

Renewals

Carrier preparesrenewals and delivers

to the client.

Renewal Rates

The client sends renewal rates to Ceridian 30 days prior to the effectivedate of the rates.

Data Entry and Verification

Ceridian will enter and verify the rate information provided

by the client. If renewal rates are not received 30 days prior to the effective date, Ceridian will make

every attempt to implement the rates in time for the

renewal. However, there are no guarantees that the rates

will be updated in time. Ceridian will bill participants at the existing rate and the client will be responsible for

any difference in premiums due.

COBRA RATEreport

Ceridian will produce a new COBRA

Rate Report and send it to the client.

Cancellations

Termination

The client informsCeridian of anyplans that haveterminated as

part of the renewal process.

Notice ofCancellation

Notice of cancelled plans must be made 30 days in advance. Client must provide

information on what plans replace

cancelled plans so that continuants

can be billed correctly.

Client Processing

ContinuantInvoices

For clients that are canceling one or more plans but not canceling services, Ceridian

follows a procedure that transfers continuants from the canceled plan to a one plan in time for billing. If information about the new plans is not provided in a timely manner, participants will continue to be

billed under the old plan.

If information about the new plans is not provided in a timely manner, participants will continue to be billed under the old plan. Changes will be made prospectively.