The main source of enrollment information about your employees and their covered family members comes from their Member Enrollment Application forms. It is very important that the forms are filled out accurately and completely.
To ensure coverage for new members and dependents, submit the completed enrollment application within 31 days after an employee or family member becomes eligible.
Enrollment information about additions and changes can be sent anytime before or during the month the transaction becomes effective. Submitting this information as early as possible helps us issue member ID cards to your employees by their effective date and will ensure timely enrollment and billing.
When are applications or member change forms required?
All applications and Member Change Forms
for newly eligible members must be signed and submitted within 31 days of the member becoming eligible for coverage.
signed by the employee and a group administrator is required when an employee is:
| Enrolling in the plan |
| Choosing coverage at a later open enrollment or because an event has occurred which allows enrollment other than during open enrollment |
A Member Change Form
signed by the employee is required when an employee is:
| Adding a newborn |
| Adding a stepchild |
| Adding an adopted child or child placed with the employee for adoption |
| Adding children previously covered by other health care coverage |
| Adding a spouse at the time of marriage or if the spouse loses other coverage |
| Returning from military service |
| Removing dependents |
| Terminating coverage|
| Enrolling in COBRA |
A signed application or Member Change Form is not required when an employee is:
| Part of a group that submits enrollment information electronically |
| Changing personal information, such as primary care physician, name, address |
Preparing Applications for Submission
Accurate and complete applications are essential to helping your employees’ enrollments proceed quickly and smoothly. Below are some tips that will help ensure your employees’ applications are ready to be submitted.
Review the information provided by your employees on the application, checking items such as:
| Completeness and accuracy |
| The effective date of coverage (typically, the first day of the month for which the application is accepted) |
| Any prior or present coverage in which the employee is enrolled |
| Employee’s signature and the date signed |
Preparing for Your Renewal
The following checklist guides you through the necessary steps to ensure a smooth renewal process.
| To help ensure your benefit changes are implemented at your renewal date, we must receive Completed changes to your current group health plan no later than the 1st of the month prior to your renewal date. For Lumenos Products, we must receive any changes prior to your renewal date. You will need to complete either a Group Master Application or Group Amendment Form. |
| Completed member applications should be transmitted, in one package no later than the 1st of the month prior to the renewal date.|
| Review the Supply Request Order form to order any necessary open enrollment supplies. Supply requests require a seven day advanced noticed to ensure your request can be accommodated timely. Please return to you Account Manager.|
| For Open Enrollment Meetings, please note there is a 7-10 day advanced notice to ensure one of our Representatives is available. Please contact your Account Manager if our Representation is needed.|
| For EET submission, please note there is a mandatory meeting with the Client’s EET Vendor and our IT Team prior to submitting an Open Enrollment EET file. Upon your approval of final renewal changes, a meeting will be requested.|
| All groups should pay as billed. If the opportunity is presented where a re-bill is necessary, one rebill will be processed upon approval by Billing, and provided the renewal is received by the 1st of the month.|
Plans that Require a PCP Selection
Our HMO and POS plans require members to choose a primary care physician (PCP) at enrollment. A PCP is a physician specializing in family practice, general practice, internal medicine or pediatrics (for members under the age of 18).
To locate an in-network doctor, your employees can simply click on the “Find a Doctor
”. For your convenience, our online directory is updated weekly.
A PCP must be designated for each enrollee. Space is provided on the application to write the full name and physician ID number of the chosen doctor, and to indicate whether the enrollee is a current patient. If the space is left blank, we will select a PCP for the member. The member may then change the PCP we have selected if desired by calling customer care or using Member Access. If the change is made by the 25th of the month, the change is effective the first of the following month.
For specific information regarding your plan’s guidelines for the use of PCPs, refer to your enrollment materials.
Remember that incomplete applications may cause enrollment delays.