L Processing Changes in Medical Insurance Coverage or Premiums

 

Program

Manual Section

All Programs

MA1502T

 

Procedures

When a customer reports changes in medical insurance or premiums, take the following steps:

Step

Action

1

Does the customer have an open application? 

  • If YES, continue to step 2.

  • If NO, open a Report a Change (RAC) application for the month the change was reported or the month of the change, whichever is later.

2

Ask the customer for the new information which may include:

  • The name and address of the insurance company;

  • The name of the policy holder;

  • The policy number;

  • The date the customer’s coverage began or ended; and

  • For ALTCS customers, information regarding premiums such as:

    • The date the customer’s premium changed;

    • The premium amount, how often it is paid and who pays it; and

    • The customer’s share of the premium if the policy covers more than one person.

3

Contact the insurance company for proof unless the customer provided all the proof needed.

4

Enter the information in HEAplus and process the change.