Onboarding Policies
Eligibility
Cards are sent to the print shop only once eligibility is verified during onboarding.
For guaranteed timely delivery of member ID cards by the plan start date, eligibility must be verified by the 15th of the month at the latest.
For 1/1 groups, eligibility must be verified by December 10th for guaranteed delivery of member ID cards by the plan start date.
Contracts
During onboarding, the SPD will be assigned to the designated signatory for the group.
The person assigned to sign the SPD will receive reminder emails every week to sign the contract.
If the contract is not signed within 30 days, Yuzu will send one final reminder to the group that services will cease if the contract is not immediately signed.
Plan Selections
All plan selections are expected to be final when uploaded into the Yuzu portal.
If there are changes post upload, PDs must notify Yuzu or risk benefit disruptions.
For renewal groups, if any plan selections change upon renewal it is expected that this will take place 30 days before the renewal goes live and that Yuzu will be notified of this change by the group or broker.
Failure to alert us of a plan change before you verify eligibility and trigger card printing will result in a card re-print fee being applied.
New Group Notification
Net-new groups must be uploaded into the Yuzu portal at least 5 days prior to the plan start date. Any late uploads must be alerted to the Yuzu team and will be handled on a case-by-case basis.
If portal to-do’s are not finalized at least 10 days before the plan start date, Yuzu may be unable to finalize the plan by the first day of coverage and RX/medical coverage may be delayed and backdated.
Accumulator Periods
If a group decides to run on a calendar year accumulation period, all accumulators must be loaded within 20 days after plan’s start date.
For renewal groups on calendar year accumulators, all benefits must stay the same year over year for accumulators to port over automatically.
If there are any benefit changes, the group must manually load accumulators.
Stop Loss Implementation
Groups must complete their stop loss onboarding and have valid stop loss contracts and configurations in the Yuzu portal for golive date.
Stop loss vendors must receive all required information from the groups and have them active in their system within 30 days following the group’s start date.
Failure to provide all necessary information will delay stop loss activation and will result in suspension of services.
Direct Contracts
Direct contracts are added during launch, not after. Plans run from the start either with or without these contracts in place, and net new contracts only apply to new claims. No claims reprocessing for late contract adds.
Plan Maintenance Policies
Invoicing
Invoices are generated on the 25th and funds are pulled on the 1st.
Exceptions to invoice dates are only granted in unique situations. Yuzu’s payments team reviews exception requests on a case-by-case basis.
The invoice for the final month of the plan year will generate on the 1st of the month.
This invoice will be based on the eligibility data on file at the time of invoicing, inclusive of any members with pending coverage effective within that final month.
No invoice will be issued after the final month of the plan year, including “post-close” invoices used to reconcile eligibility adjustments following the final invoice.
Clients are responsible for ensuring that all eligibility data is accurate prior to the generation of the final month invoice.
Any eligibility changes that come after an invoice has been generated will not show up on that month’s invoice and will be automatically reconciled on the next month’s invoice.
Groups must have a bank account on file so Yuzu can withdraw each month’s invoice and distribute payments to vendors.
If a payment fails or is reversed, Yuzu will notify the Plan Designer so the group can update their banking details or resolve the issue promptly.
If the group continues to fail to make the monthly payment, all claims processing and outgoing payments will be suspended until the outstanding balance is paid.
If the issue remains unresolved, Yuzu reserves the right to terminate the group per the Administrative Services Agreement.
Plan Switches
There is a 30 day window to correct inaccurate member plan election. After the initial 30 days, Yuzu assumes all members were assigned to their accurate plan election and will adjudicate claims accordingly.
Members may also switch plan selections during special enrollment periods. For unique situations, Yuzu’s Account Management team reviews requests on a case-by-case basis.
Waiting Periods
Groups may switch waiting period language up until the end of the first 30 days of the plan
If the waiting period language is changed after the plan start date, Yuzu will require evidence of approval from the group’s stop loss vendor.
Yuzu does not permit waiting period changes after the first 30 days of the plan year without the issuing of a Summary of Material Modifications (SMM). In the case of a late waiting period change, the employer, broker, or plan designer is responsible for issuing the SMM to all group members.
Vendor Changes
Any vendor changes after a group’s start date will require an updated SPD and may require approval from stop loss.
COBRA vendors cannot be changed from Yuzu-managed → external once a member has already elected Yuzu COBRA.
Eligibility Maintenance
The employer/broker must keep track of eligibility changes and update the portal accordingly. Yuzu is the source of truth for eligibility information for payment purposes but it is up to the employer/broker to notify of changes.
Up to 30 days for an employer to notify of census issues/changes.