Hello and Welcome to BRI COBRA, LLC, A Division of Benefit Resource (BRI)!
Below you will find helpful links to the information needed to complete your plan set-up. We ask that you complete and return the following as soon as possible:
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REQUIRED:
- Carrier and Rate Information sheet: Outlines the insurance plan(s) and rates offered which will need to be included as part of the COBRA notification process.
- If COBRA implementation coincides with a renewal period, please provide plans and rates for both plan years.
- Please also include applicable benefit summaries for participants and note that the Eligibility Contact refers to your dedicated group rep at each carrier.
- Assignment of COBRA Administrator form: Used to formally assign BRI COBRA, LLC as COBRA administrator for purposes of notifying the carrier(s) of member enrollments/terminations/changes. You will need to ensure that COBRA billing group numbers are appropriately assigned to bill the employer along with the active employee invoice. Please copy the language, sign, and paste onto company letterhead.
- BRI COBRA, LLC wishes to obtain online access to COBRA enrollment portals whenever possible.
- Headcount Form & copies of your most recent insurance invoice(s): Used for COBRA/Direct Bill invoices for services. We update this number on a yearly basis but also ask for communication to us if the covered life count changes by more than 10% at any point during the year. We would adjust the count, as applicable, at that time.
- If we do not receive this in writing from you at this time, BRI will use the number provided to the sales /account executive during discovery.
- QB Spreadsheet: Used to gather records of any current QBs (pending 60-day enrollment window and current COBRA participants). We will then require this spreadsheet on an ongoing basis to capture new qualifying events (or they can be entered manually through the client portal, or setup for EDI file feed).
- SPM Spreadsheet (if Direct Bill): Used to gather records of any current Retirees and/or Special Plan Members. We will then require this spreadsheet on an ongoing basis to capture new member (or they can be entered manually through the client portal).
- COBRA/Direct Bill Contact Form: Used to gather information about where and whom to invoice and send remittance payments. Also used for BOR changes.
- ACH Authorization Form: Used to collect banking information to initiate debit entries to our company bank account for the purpose of paying monthly invoices and / or to transfer participant premium payments to you via ACH. Please complete.
- BRI COBRA, LLC W-9
OPTIONAL (IF APPLICABLE):
- Payment Instructions: For your records: The options you have to remit payment for your monthly administration invoices.
- NPM Spreadsheet: If you wish to have Initial Notices sent to all active employees at the time of our takeover, please complete. Otherwise, we will only require this spreadsheet moving forward for newly enrolled employees (or they can be entered manually through client portal, or setup for EDI file feed).
HELPFUL:
- COBRA/DB Implementation Guide: An example of what you can expect from your implementation.
- COBRA/DB Fact Sheet: A description of the services you can expect from BRI COBRA & Direct Billing.
- Establishing a COBRA File Feed: A guide to help you understand the process of setting up a file feed with BRI COBRA.
Additionally, login information and credentials for the COBRApoint Client Self-Service Portal will be sent to the designated contact(s). We encourage you and your staff to utilize this tool. Please let us know if you’d like to schedule a demo, or you can view one here at your convenience.
- If you do not have an EDI feed in production at the time of your effective date you will be responsible for entering new plan members and qualified beneficiaries directly into the portal.
