This excerpt taken from the GVHR 10-Q filed Nov 10, 2008.
XI. Administrative Policies
A. Enrollment Methodology
The Groups human resource staff will enroll each new client groups employees via the Groups Benefit Election Form or other acceptable method (IVR or web application). On a [*] basis, the Group will present to BCBSF an automated enrollment file. Enrollments will be accepted as submitted from the Group. BCBSF/HOIs assigned Personal Service Representative (PSR) will review discrepancy reports produced from the automated enrollment file and work reports directly with the Groups assigned staff member to resolve all enrollment(s) on a timely basis.
B. Identification Cards
D. HOI Primary Care Physician Assignment
If an HOI member does not choose a Primary Care Physician (PCP), BCBSF/HOI will assign a PCP based on the members home address. A letter will be generated advising the member that a PCP was assigned and offering them the option to change if they so desire. The member may call the customer service number on their identification card to initiate the change. When a member changes their PCP, the effective date of the change is determined by the time of the month the change is requested. If a member requests a change between the 1st and 15th of the month, the member is eligible to utilize the new PCP the 1st of the following month. Changes requested after the 15th of the month, will be effective the 1st of the second month following the month the member made the request (Example: PCP change requested January 20th. PCP would be effective March 1st.)
1. The Groups Benefit Election Form
Each employee applying for coverage must complete a Benefit Election Form or be enrolled through the Gevity web application.
2. Status Change Form
* THIS CONFIDENTIAL INFORMATION HAS BEEN OMITTED AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION.
CONFIDENTIAL TREATMENT REQUESTED BY GEVITY HR, INC.
Any membership change, i.e., marriage, divorce, addition of newborns, etc., will require completion of a Status Change form (paper or through the Gevity web application). The Group will retain adequate documentation of status change requests for a reasonable period of time in the event BCBSF/HOI requires copies to respond to an enrollment inquiry. All qualifying events have a notification timeframe mandated by the Plan. To the extent allowed by State law, newborns will be covered back to the date of birth.
If changes are not submitted within the specified time frames, the member must wait until the next annual enrollment to make changes except under HIPAA requirements for special enrollment.
The Group has chosen to administer COBRA on an internal basis. COBRA enrollment will be provided to BCBSF/HOI on a weekly basis directly to the assigned PSR of the Membership/Billing Area. Unless otherwise stated, the Group will be responsible for all COBRA administration including notification requirements. All previously stated enrollment guidelines will apply.
G. Overage Dependent Status Verification
BCBSF/HOI is responsible for verifying overage dependent childrens eligibility status on at least an annual basis. Any overage dependent who is no longer eligible will be reported to the Group so coverage can be terminated.
H. Disabled Dependent Verification
BCBSF/HOI is responsible for verifying the disability status of overage dependent children on at least an annual basis. Any overage dependent child who is no longer disabled will be reported to the Group so coverage can be terminated.
I. Creditable Coverage
The Group will report to BCBSF/HOI the amount of creditable time to be applied to satisfy the pre-existing condition exclusion limitation for those members providing that information at time of eligibility. If this information is not supplied, BCBSF/HOI will deny the impacted claim. The denial advises the member that if they had previous coverage a credit may be applicable and to please contact customer service. Once information is received and reviewed, the claim will be reprocessed and pre-existing condition limitation updated in their system. The Group will not track creditable time in their system.