Frequently Asked Questions

What are the advantages of being in the NCACC Risk Management Pools?
Who owns the Pools?
What benefits do I receive as a member of the Pools at no additional cost?
What is the difference between an Administrative Services Only or self-funded Program (ASO) and a Standard Program?
How long does it take for stop-loss credits to show up on my invoice?
Who is responsible for communicating HIPAA privacy issues?
How do you add or delete an employee or dependent?
Do I have the option to modify my plan to help manage my costs based upon utilization?
How do you determine an employee's COBRA rate?
Do I need to retain someone for rate forecasting, IBNR figures, etc.?
Does the Pool Provide inmate medical coverage?

What are the advantages of being in the NCACC Risk Management Pools?
The NCACC is focused on designing and delivering risk management programs that meet the unique needs and exposures of the counties. The Pools, which are not-for-profit, are governed by a Board of Trustees which is comprised of county elected officials and county government staff.

Who owns the Pools?
The Pools are owned and governed by the participating members - the North Carolina counties and county entities.

What benefits do I receive as a member of the Pools at no additional cost?

Access to the new CAPE network
Access to the CIGNA North Carolina and national provider networks, disease management programs, claims administration, mental health and Caremark's pharmaceutical programs.
Stop-loss coverage provided by the pool
Annual, quarterly and monthly reporting on group claims activity through MedStat
Pooling and group purchasing power to assist in controlling costs
For self-funded groups, a certified actuarial statement on IBNR
Hands-on and attentive customer service provided to you by NCACC staff
Cost controls on administrative fees
No-charge COBRA administration for health or dental benefits

What is the difference between an Administrative Services Only or self-funded program (ASO) and a Standard Program?

Administrative Services Only (ASO)
Administrative Services Only groups is a self funding mechanism through the NCACC Group Benefits Pool. Services are provided for group medical specific, aggregate, and administrative rates and dental administrative rates at a specified amount for a 12-month period. An Expected Claims rate (dollars incurred) is set from the claims experience the member has provided to the pool. In addition to the expected claims payments the member is responsible for Specific Stop Loss, Aggregate Stop Loss, Administrative Costs, and other costs if applicable.

The Member is at full risk on the account. CIGNA and Caremark administers the paid claims for NCACC-GBP. The member group purchases specific and aggregate stop loss from NCACC-GBP.

All claims paid in a given month are the responsibility of the member and their chosen specific stop loss is applied to each member’s cumulative claims. Once a claim reaches the specific level, the member group is reimbursed for claims amounts over the stop loss in their monthly standing of accounts. Aggregate Stop Loss does not apply until the end of the contract year when all paid and incurred claims are adjudicated. The Pool will settle up with the group approximately two months after the close of the plan year.

Standard
Standard funding programs from the NCACC Group Benefits Pool are designed to provide group medical and or dental coverage at a specified set of rates for a 12-month period. The rates are inclusive of all costs including expected claims, administrative fees, specific pooling and incurred but not reported claims. The Members purchase set rates on a tiered basis for employees and dependents.

Rates are developed from group experience, NCACC-GBP manual/book rates and/or a combination of both. The NCACC Group Benefits Pool takes on the full risk of these groups.

Available for all size groups.

How long does it take for stop-loss credits to show up on my invoice?
Group Benefits tracks stop loss on a monthly basis. Therefore, you should expect to receive stop-loss credits no later than two billing cycles after the claim is paid. Actual monetary credits are given only to self-funded groups and show as Stop-Loss Credits on the monthly standing of accounts.

Who is responsible for communicating HIPAA privacy issues?
The NCACC issues a Notice of Privacy to each new main subscriber on the Group Benefits Plan. Likewise, the Pool retains Business Associate Agreements with its ASO Member Groups, Large Groups (those having over $5 million in annual contributions) and its vendors. The Pool has taken all reasonable steps to insure compliancy in its own operation and that of its vendors.

Counties have HIPAA implications that go beyond the group health plan and should consult with their county attorney and/or Privacy Official for help with HIPAA compliance.

How do you add or delete an employee or dependent?
All modifications to an employee’s coverage or the enrollment of a new employee or dependent must be done in writing on the NCACC's forms. Once the Manager Self Service has been provided to a member group these types of enrollment activities can be handled at the member level through the internet and paper enrollment forms will not be necessary. The NCACC will collect the data within its Benefits Workstation system. Two times weekly, the NCACC will send a full file transfer to CIGNA and Caremark. They will receive the data and download it into their system. Any system discrepancies or “kick-outs” will be worked through a concerted effort between the NCACC customer service unit and CIGNA and Caremark. Once the data is uploaded it overwrites the record (or adds the record). An ID card is prompted and sent to the member, when applicable.

Do I have the option to modify my plan to help manage my costs based upon utilization?
You may modify your plan(s) annually at renewal with the advice of our marketing representatives.

How do you determine an employee's COBRA rate?
COBRA rates are based on the contribution amount currently being paid by tier. The member does not establish the amount charged for COBRA; instead, the Pool requests that ASO members provide to the Group Benefits Pool the amount they charge employees, by tier. This is truly the amount that is charged to a COBRA participant.

Do I need to retain someone for rate forecasting, IBNR figures, etc.?
It is always your option to seek outside advice in these areas; however, the Pool provides these services to you free-of-charge.

Does the Pool Provide inmate medical coverage?
The Group Benefits Pool does not provide inmate medical coverage; however, there is inmate medical coverage available through Marsh that acts like specific stop loss coverage. Counties may choose levels of $5,000, $10,000 or $25,000.