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NHS Application Guide Formal Groups

A step-by-step guide to implement Kaiser International Healthgroup’s National Healthcare Shield (NHS) for Formal Groups. Formal groups are entities that are government regulared, e.g. companies, government agencies, SEC registered associations, and unions, and cooperatives registered/regulated by theCooperative Development Authority.

Process Flow of Formal Group

1. Identification of the Group:
   • Most government agencies have a government employee associations, union or cooperative
   • Decide which entity will be the contracting party for the HMO Agreement with Kaiser
   • Decide which entity will be paying the annual premium for the employees, and the required documentation to enable the entity to document, pay and receive proof of payment.
   • For example, a government entity X may have an employee association X-EA (X employee asociation), which it may task to look for an HMO agreement with provider Y. However, agency X may decide to pay the provider directly
2. Documentation:
   • Prepare the certification of identity (e.g. SEC registration, CDA registration, etc) which proves the legal existence of the group
   • Prepare a notarized certification or board resolution or Secretary Certificate from the group, authorizing a person to execute the HMO agreement
3. Duties of the Leader:
   • Sign documents and the agreement on behalf of the group.
   • Represent its members in dealings with the HMO PROVIDER;
   • Coordinate with the GROUP to validate membership lists and eligibility;
   • Facilitate any and all communication between the GROUP and the HMO PROVIDER in relation to matters under this Agreement;
   • Assist members in availing benefits and resolving concerns regarding coverage for principal members and dependents;
   • Ensure that any changes in membership status, are promptly communicated to both the GROUP and the HMO PROVIDER.
4. Requirements:
   • Certificate of Govt Employees’ Association / Agency / Cooperative
   • Secretary’s Certificate or Appointment Letter for Authorized Signatory
   • If Agency/Coop: Board Resolution or President Certificate
5. Depending on agency arrangements / protocols, a second MOA may be executed to satisy any legal documentation, payment and reportorial requirments

Detailed Initial Steps

To implement Kaiser International Healthgroup, Inc’s National Healthcare Shield (NHS) for teachers at the school level, even without direct Division Office endorsement, simply follow the following steps.

These detailed initial steps implement steps 1, 2, and 3 in the "NHS Step-by-Step Implementation - For Principals and School Heads:

1. Call a meeting and present NHS benefits.
   • Invite Kaiser representative for product presentation,
   • Scan the QR code on the right to watch presentation and details videos.
   • Highlight features
2. Secure consensus from teachers:
   • Prepare and sign a Faculty / Board / Authorization Resolution
   • HMO companies approve group HMO plans based on anti-selection, hence enrollment must be by entire groups; possible exceptions are those who already have HMO benefits.
3. Collect premiums:
   • Option A: Cash collection by a committee (with acknowledgment receipts).
   • Option B: Salary deduction (if coordinated through payroll / Division Office).

Detailed Closing Steps

These detailed closing steps implement steps 4, 5, and 6 in the "NHS Step-by-Step Implementation - For Principals and School Heads:

4. Prepare documents
   1. Submit conforme document, stating group name, signatory, position title and address to Kaiser International through the Kaiser agent.
      Download nfs-conforme.pdf file.
   2. Submit notarized certification of authorization, such as a Faculty Resolution
      • Faculty resolution
        Download Resolution draft.
        Adjust as necessary to satisfy your group’s documentation requirements.
      • Annex A. List of Principal Members.
        Download nhs-fr-annex-A.xlsx spreadsheet.
      • Acknowledgement / Notary certification, (included in draft in item (a) ).
   3. Receive final copy of Memorandum of Agreement via email from HMO provider
5. Memorandum of agreement
   1. Print and sign four (4) copies of Memorandum of Agreement in coordination with HMO provider
      • if face to face, then the document just need to be notarized
      • if remote (in different locations), see remote signing instructions.
   2. Submit Masterlist of Principal and Dependents
      Download nhs-group-masterlist.xlsx
   3. Remit Payment
      See Payment Instructions.
6. Rollout
   1. Receive proof of membership
      • HMO agreement
      • Official receipt with name of members
      • Individual membership cards

If the signing of documents will be done remotely ( not face to face ), see remote signing instructions

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