Health Insurance Online

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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 capitaltaining 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 moment of cogent dates.

When making a change to your company’s membership roster, it’s important to clearly indicate the date the change should take effect. Furtherfurther, when adding an employee and/or a dependent, inform your health benefits company prior to the competent 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 active date.

Understand retroactive additions and terminations.

Retroactive additions and terminations are membership changes that are communicated after the able 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.

About The Author

KRIS HAMMOCK is senior director of enrollment and billing for
VISTA, a health benefits company headquartered in South Florida
with greater than 300,000 members. She spearheads the commercialenrollment and billing operationsfor the company. With 14 years ofhealth insurance experience, Hammockhas been involved in various aspects ofthe industry, including claims, customer
service and utilization management. Reach her at (954)965-3113 or kristin.hammock@vistahealthplan.com.

© 2005 Smart Business Network Inc. Reprinted from the May 2005 issue of Smart Business Broward/Palm Beach.

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Tags: Health Insurance