HCSO PLANS
 
 

AGU San Francisco Limited Accident & Sickness Indemnity Plan


Administration



Simple And Convenient



The administration procedures for this plan have been customized to make complying with the HCSO uncomplicated and straightforward for employers who are subject to the law.

Each month, it’s as easy as multiplying the number of hours worked by each covered employee times the rate per hour ($1.89 or $2.83 per hour depending only on the size of the group) and sending a check for the premium.

Starting and ending coverage for new employees and those who terminate is easy too with AGU initiating certificate and ID card issuance, premium collection and customer service.

NO OTHER HCSO COMPLIANCE SOLUTION REQUIRES LESS TIME AND EFFORT ON THE PART OF THE EMPLOYER


Expand Each Section Below for details



Hours Worked Self-Reporting By Employer
The employer will self-report actual hours worked monthly in arrears for all enrolled employees. The report must show the name of each employee and the total number of hours worked by that employee in the month. Aggregate total reports cannot be accepted. Enrolled employees who do not work any hours during the month should be reported showing zero hours. Indicate on the report “Addition” or “Termination” and the date of the event for each employee added or terminated during the month.

Premium Calculation And Remittance
Large Groups (100+ employees worldwide) – calculate and remit $2.83 per hour worked for each enrolled employee.

Medium-Sized Groups (51-99 employees worldwide) – calculate and remit $1.89 per hour worked for each enrolled employee.

Reports and payment of the full calculated premium are due to AGU on or before the 5th day of the month following the reporting month (for example: the report with April hours worked should be submitted by the 5th of May). Since this premium is being paid in arrears, there is no grace period.

Send reports and premium payments to:
Affinity Group Underwriters
SF Plan
Attn: Lori Mills
4510 Cox Road, Suite 111
Glen Allen, VA 23060


  1. Premium is not required for hours worked by any one employee in excess of 172 hours for the month.

  2. Enrolled employees working fewer than 8 hours per week - Actual hours must be reported and premium paid for all enrolled employees even if the employee works fewer than 8 hours in a given week. The Ordinance requires that contributions be made for all employees who average 8 hours per week over the previous 90 days . Once an employee’s average hours for the previous 90 days falls below 8, coverage for that employee should be terminated.

To add a new employee or terminate an employee’s coverage, employers simply notify AGU of the change(s). All changes should be reported within 5 days of the event.

Additions -
Coverage for a new hire who meets the eligibility requirements will be effective on the 91st day after the employee’s hire date. New hires should be reported within 5 days of their effective date (91st day after hire date). An ID card will be mailed to the employee’s home address as soon as notification is provided.

Terminations -
Coverage for an employee will terminate at the end of the month in which employment terminates. Termination should be reported within 5 days of the last day of employment.

Please Note:
Simply noting additions or terminations on the monthly premium report will not generate a change to the employee’s record.

Failure to report additions means that new employees will not have coverage, receive ID cards or be able to obtain discounts on prescription drugs. In addition, employers could be fined by the City for failure to make the required contributions under the Ordinance.

Failure to properly report terminations results in continuing premium liability for the employer.



For most* of the benefits under the AGU San Francisco Limited Accident & Sickness Indemnity Plan, no claim form is required. Simply submit (or have your provider submit) an itemized bill to the Claims Administrator:

Administrative Concepts, Inc. (ACI)
994 Old Eagle School Road, Suite 1005
Wayne, PA 19087-1802

If you have questions about submitting a claim or the status of an existing claim, call ACI toll-free at 800-964-7096.

If ACI has any questions about your claim, they will contact you in writing and request any additional information that may be required in order to process your claim.

*Claim forms are required for accidental death or accidental dismemberment claims. Call ACI toll-free at 800-964-7096 to request the appropriate claim form.