January 1st is almost upon us, here are some important reminders to help you provide the best possible service to your clients this enrollment season.
ID Cards
Members should not use their existing ID card after the new policy's effective date, even if they haven't received their new carrier's ID card.
Prescriptions
- Prescription refills should be completed PRIOR to the new policy's effective date to avoid extra out-of-pocket costs and claim filing.
- Drug formularies differ by carrier; share the new carrier's formulary with members so they can determine if their prescription falls into a different tier.
- Transfer all Mail Order and Specialty prescriptions to the new carrier's vendors.
Preauthorization
Carriers will not preauthorize any medical treatment or prescription until the member is loaded into the carrier's eligibility system.
PCP Selection
- If an HMO member did not request a PCP during enrollment, they must visit the PCP assigned by the carrier to receive benefits.
- A PCP change request may be made by contacting Member Services, to be effective the first of the following month.
COBRA & CalCOBRA
Confirm all COBRA and/or CalCOBRA members have been notified of the change of carrier.
Termination of Coverage
- Do not terminate existing group coverage until the new group coverage has been approved; Delta Dental is the exception.
- Once the new group coverage has been approved, complete the Prior Coverage Cancellation Letter and submit to the carrier.
For questions, please contact a member of your B&P Sales Team - 888.722.3373.
