Making Changes to Your Enrollment Roster

 


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Health insurance companies face increasing pressure to stay competitive in today’s marketplace. Having a competitive stance goes beyond offering affordable health benefits packages — it also involves having superior service, such as an efficient billing and enrollment process, that provides a hassle-free experience for customers.

The majority of billing and enrollment tasks involved in administering your health benefits plan are the responsibility of your health insurance carrier. However, understanding the role you or your company’s benefits administrator plays in maintaining a current enrollment roster is integral to establishing a positive working relationship with your health insurance carrier.

Carefully reviewing your roster, making changes in a timely manner and understanding your carrier’s retroactive change policy will help ensure accurate billing and that your employees receive access to covered services.

Review your membership/enrollment roster.

Typically, your monthly health insurance invoice will include a membership or enrollment roster that indicates the current number of covered employees and their dependents. Review this roster carefully and communicate any discrepancies.

Notify your carrier of membership changes.

Throughout the year, it may become necessary to make changes to your company’s enrollment roster — you hired a new employee, an employee had a baby or someone left your company. Whether you are adding or removing individuals, reporting these changes in a timely manner will help ensure that they are reflected on your next monthly bill.

Understand the importance of effective dates.

When making a change to your company’s membership roster, it’s important to clearly indicate the date the change should take effect. Furthermore, when adding an employee and/or a dependent, inform your health benefits company prior to the effective date. This enables your carrier to complete the entire enrollment process and helps ensure that the new member has access to covered health care services by his or her effective date.

Understand retroactive additions and terminations.

Retroactive additions and terminations are membership changes that are communicated after the effective date. Most health benefit companies have restrictions on how long employers have to make a retroactive change and also have policies about the types of documents that must be submitted with the request.

The process of making enrollment changes varies from company to company — the above tips should only serve as a guide. Be sure that you or the company’s benefits administrator know your health insurance carrier’s specific policies. Knowing the process and how to navigate the system will help both companies — yours and your health insurance carrier — achieve the mutual goal of providing your employees with a positive and hassle-free health plan experience.

KRIS HAMMOCK is senior director of enrollment and billing for VISTA, a health benefits company headquartered in South Florida with more than 300,000 members. She spearheads the commercial enrollment and billing operations for the company. With 14 years of health insurance experience, Hammock has been involved in various aspects of the industry, including claims, customer service and utilization management. Reach her at http://www.vistahealthplan.com

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