FAQ’s for Citygate Network Benefits Program

For the 2019 Healthcare Program



Does my organization need to become a Citygate Network member in order to join the Citygate Benefits program and if so, is there a fee?
Yes, all member organizations within the Citygate Benefits program need to be members of Citygate Network. Membership dues have recurring annual membership fees. For more information please visit https://www.citygatenetwork.org/agrm/Become_a_Member.asp


How does each member organization attest that they will participate in the association’s plan? Is there a contract we would have to sign?

A well-defined, uniform and straightforward process has been developed by Citygate Network to administer the program. This process begins with the comprehensive website [www.citygatebenefits.com] which houses information about every component of the program and provides detailed instructions on how members can join the program. Members will be able to learn via the website as well as direct communication with the Citygate Benefits team via the “get started” button on the website. Once the online ‘Get Started’ form is completed a secure email will be sent with (1) PlanSource on-boarding questionnaire (2) Plan Agreement (3) Instructions for the program deposit (4) Group Health Risk Assessment. Once a member completes these items and has satisfied any applicable underwriting requirements, they have “joined” and will begin the implementation process with PlanSource. The information each member submits will be used to build a unique profile within the PlanSource system based on that organization’s needs and preferences.


Will Citygate Network establish a Health and Welfare Benefits Committee?
Yes, Citygate Network leadership has established a Health and Welfare Benefits Committee for this program. The Committee is comprised of HR/Benefit professionals and/or executive leadership from organizations actively participating in the Citygate Benefits program. These individuals will work together to enhance the ability of all participating organizations to procure competitive, objective and transparent employee benefit programs that exemplify quality, stewardship, integrity and unity. Committee members serve a two-year term.


What is Citygate Network’s Administrative Responsibility?
Our selected TPA partners will carry the lion’s share of administrative responsibility, but Citygate meets with ERS, PlanSource and Cigna in order to provide sufficient oversight of the program. Citygate will also be involved in promoting the program, encouraging members to submit needed information, and answering general member inquiries related to the program.


What is Enterprise Risk Strategies’ (ERS) Role?
ERS is Citygate Network’s consulting partner and has been working with our organization developing and launching this program. They are responsible for the overall plan implementation/launch, ongoing plan management, vendor management, actuarial analysis, data analysis/reporting, renewal management and overall strategy in collaboration with Citygate and its committee.


What is PlanSource’s Role?
PlanSource is serving as both our Benefits Administration Solution, Benefits outsourcing/call-center partner and Consolidated Billing TPA. PlanSource will receive premium payments, pay claims, provide and manage the call center for members, and provide the technology solution that members use for enrollment and managing the plan within their organization (gathering information from employees, setting up contributions, etc.).


Is there a minimum participation requirement to join the Citygate Benefits program?
While Citygate Benefits accepts all groups regardless of size we do have participation requirements that participating groups must follow. Groups of 1 or 2 employees must have 100% healthcare participation from benefit eligible employees. Groups of 3+ employees must have at least 50% healthcare participation from benefit eligible employees. Waivers are provider to employees that meet certain parameters such as being enrolled in a spouses plan or a federally based program such as Medicare, Medicaid or Tri-Care.


How will the Program be Funded?
Funding comes from two sources: (1) Participating members will pay a deposit of $159/employee enrolled in healthcare. Members that do not currently offer healthcare will pay a deposit based on 75% of their eligible full-time employees. An organization that chooses to leave the program after the first plan year would lose their deposit. (2) The second, and primary source of funding, will be member premiums.


Can our organization offer other benefit programs alongside the Citygate Benefits program?
Participating organizations are not able to offer alternative (competing) benefit programs alongside the Citygate Benefits program. That said, we do allow a life and disability exception for organizations that offer retiree life benefits given our program does not provide retiree coverage. As such, if you currently offer retiree life benefits, we will allow your organization to “opt-out” of Citygate’s life and disability program. Organizations that choose opt-out and provide an external life and disability program will be responsible for administering these programs on their own as they will not be reflected in the Citygate Benefits administration system.


Will Citygate Benefits allow deductible carryover from our current healthcare program?
No, we are not administering/allowing deductible carryover into the Citygate Benefits program.


What are the Fixed Costs?
Fixed costs include: Third-Party Administrator (TPA) fees, centralized billing, benefit administration, marketing fund, data warehouse/analytics, stop-loss coverage and consulting fees.


What is Cigna’s Role?
Cigna serves as the Medical, Rx and Dental TPA and also provide stop-loss insurance coverage.


What is VSP’s Role?
VSP serves as the Vision Insurance provider.


What is The Standard’s Role?
The Standard serves as our ancillary benefits provider with products such as Life, Voluntary Life, Short- & Long-Term Disability Insurance and Accident Insurance.


What is HCMS’s Role?
HCMS manages our integrated data warehouse, provides predictive analysis/advanced analytics and engages with high-risk/high-cost members through their predictive high-risk intervention model.


What is the Role of Individual Insurance Brokers that Members Choose to Use?
Members may choose to retain the services of a health insurance broker or consultant. These organizations can serve as “boots on the ground” for direct communication and as a liaison between member and program. Much of what brokers typically do will be handled through the Citygate Benefits infrastructure. Brokers will share plan fees with ERS.


How do we handle the transition of our current HSA or FSA accounts and account values to Citygate Benefits?
The plan for transition of current HSA and FSA accounts and values is coordinated during the implementation process. The process will depend on what can be supported by your current HSA/FSA administrator.


HSAs – Employees typically have to complete an HSA transfer form that they send to their prior HSA custodian, initiating a transfer for their HSA funds to their Citygate Benefits HSA. The transfer form they need to complete depends on who your current HSA administrator is and we will discuss that during the implementation process. If a group is large enough (over 100 to 200 employees) there may be an option to perform a bulk transfer of accounts and that process can be discussed during implementation if it is an option.


FSAs – The prior FSA administrator will either continue to pay out claims for the plan year they were administering or employee balances can be loaded into the Citygate Benefits system. If balances are loaded into the Citygate Benefits system there will be a required “blackout period” (typically a week) where employees cannot use their prior FSA administrator’s card or submit claims. This ensures accurate balances are loaded into the Citygate Benefits system.


What am I going to be responsible to administer on HSA or FSA accounts we use in the Citygate Benefits program?
You are responsible for the following:

  • Joining the Citygate Benefits program will streamline many of the HSA/FSA tasks you’ve had to manage in the past including:
    • Managing enrollment/elections in multiple systems.
    • Managing EDI/file feeds.
  • Some of the key areas you will still be responsible to administer include:
    • Ensure employee election amounts are correct in the PlanSource system.
    • Ensure employees are enrolled/terminated timely in the PlanSource system.
    • Sending HSA contributions to each employees individual HSA via ACH each pay period.
    • FSA claim and debit card aggregate amounts will automatically be pulled from a bank account you provide (typically done daily. Weekly and monthly options available if you provide a pre-fund amount that is between 5% to 10% of your annual elections).
    • Have a high level understanding of how employees access their online account and what tools/resources are available.
    • Have a high level understanding of why FSA debit card transactions sometimes require employees to submit receipts.
    • Understand how employees enrolling in an HSA go through the Consumer Identification Process (CIP) and that if they are asked to provide information (Driver’s License, Birth Certificate, Social Security Card, etc.) that they need to do that before their HSA can be opened and HSA contributions loaded into it.


What is the renewal date of Citygate Benefits?
The renewal date is January 1.


When do Deductibles and Out-of-Pocket Maximums reset?
January 1, corresponding with the plan renewal.


How are pharmacy rebates handed within this program?
As we launch this program, we have done everything possible to minimize fixed cost, thereby reducing the premiums employees have to pay. As such, an incentivized pharmacy credit has been included in the Cigna Medical/Rx TPA quote which has significantly reduced their annual TPA cost (in leu of Citygate Network receiving quarterly pharmacy rebates down the road). Once pharmacy consumption data is collected ERS will advise Citygate Network and its Benefits Committee as to potential changes to this structure based on what is in the best interest of Citygate Network and its participating member organizations.


Will run-out claims have stop-loss protection for members that leave the program?
Citygate Network and its members will continue to have stop-loss protection for all claims incurred while insured under the program. An organization that chooses to leave the program within the first two years of their effective date may be responsible for run-out claims up to applicable stop-loss thresholds.


Is the deductible embedded into the out-of-pocket maximum in the HSA Plans?
Yes, the deductible is embedded into the out-of-pocket maximum in the HSA Plans.


Does the deductible apply before the coinsurance for Inpatient/Outpatient hospital and prescriptions?
Yes, the deductible would apply before the coinsurance for Inpatient/Outpatient hospital for all plans and for the HSA on prescriptions. However, the deductible would not apply for prescription on the PPO plan.


Will Citygate Network receive monthly or quarterly statements on its claims account and its balances?
Yes, Citygate Network receives weekly claim/banking updates and also receives detailed integrated claims and advanced analytics/predictive modeling on a monthly basis via our online data warehouse called OBI (Online Business Intelligence).


How are the claims up to stop-loss attachment point administered and who will receive and review these reports?
All claims below the specific stop-loss thresholds will be paid from the Citygate Network benefits account which as stated above will be managed/administered by PlanSource. Citygate Network has access to claim reports as well as access to an integrated data warehouse called “Online Business Intelligence” or OBI for short. OBI will consolidate all data flowing through the Citygate Benefit Medical/RX program and allows us to look at a nearly infinite number of variables tied to the programs aggregate data for the purposes of reporting and broader plan stewardship.


What are the medical plans and corresponding rates?
For current medical plans and rates please click on the following link: https://citygatebenefits.com/cigna/


Is there a penalty if an organization chooses to leave the plan?
Should a participating organization chose to leave the Citygate Benefits program, they may (1) loose their deposit) and/or (2) be required to pay their run-out claims if they’re leaving within the first two years of their initial effective date.


Is the Group Risk Health Assessment processed yearly or is this a one-time evaluation?
This is a one-time evaluation that will not be repeated in subsequent years.


Our organization does not have a January 1st renewal date so how do we join the program given our renewal date doesn’t align with this new program?
Many organizations do not currently have a January 1st renewal date. That said, the transition to a January 1st plan year is very simple via a “short plan year”. If you are not joining on January 1st just go through your normal healthcare renewal process and then provide a 30-day (minimum) cancelation notice to your current health insurance vendor. You will then go through the enrollment process for the Citygate Benefits program and new ID cards will be sent to your employees based on the date you choose to join. We call this a “short plan year” because on January 1st the Citygate Benefits program will renew for your organization along with any applicable plan/rate changes.

If your organization is currently not in a traditional, fully-insured healthcare program please contact our team at benefits@citygatenetwork.org com to discuss options and determine how we can best assist with the transition.


Is there COBRA continuation coverage through Citygate Benefits?
Yes – any actively enrolled Citygate members covered on the medical and/or dental plans (Cigna) or vision plan (VSP) are able to continue coverage should your organization allow them to.


Are there any pre-existing condition limitations in the Medical/Rx program?
No. There are no pre-existing condition limitations in the Citygate Benefits Medical/Rx program.


Are there any annual benefit limitations in the Medical/Rx program?
No. The Citygate Benefits Medical/Rx program has an unlimited benefit maximum.


Are domestic partners covered? No. The employee and spouse must be legally married and of the opposite sex.


What is included in Preventive Generics? Click the following link to view the full list of preventive generics https://citygatebenefits.com/cigna/