CHANGING FAMILY MEMBERS. ON THE MEMBER’S PLAN The Schedule of Eligibility lets the Member know when it is necessary for the Member to apply for coverage to enroll additional family members to the Member’s plan. A Group Enrollment Change Form is the document that We must receive in order to enroll family members not listed on the Member’s original application/enrollment form. The Group Enrollment Change Form is used to add newborn children, newborn adopted children, a Spouse, or other Dependents. It is extremely important that You follow the timing rules in the Schedule of Eligibility. If You do not complete and return a required Group Enrollment Change Form to Us within the timeframes set out in the Schedule of Eligibility, it is possible that Your insurance coverage will not be expanded to include the additional family Members. Completing and returning a Group Enrollment Change Form is especially important when Your first Dependent becomes eligible for coverage or when You no longer have any eligible Dependents. FILING INSURANCE CLAIMS FOR BENEFITS The Company and most Providers have entered into agreements that eliminate the need for a Member to personally file a Claim for Benefits. Participating Providers will file Claims for Members either by mail or electronically. In certain situations, the Provider may request the Member to file the Claim. If the Member’s Provider does request the Member to file directly with the Company, the following information will help the Member in correctly completing the Claim form. If You need to file a paper claim, send it to: United Concordia Dental Claims Department P.O. Box 69441 Harrisburg, PA 17106-9441 The Member’s Blue Cross and Blue Shield Identification Card (ID card) shows the way the name of the Subscriber (Member of the Group) appears on the Company records. (If the Member has Dependent coverage, the name(s) are recorded as the Member wrote them on his enrollment form.) The ID card also lists the Member’s contract number (ID #). This number is the identification to the Member’s membership records and should be provided to Claims Administrator each time a Claim is filed. If the Subscriber completes the Claim form and this is a Group plan, remember: the Subscriber is the Employee Member (if this is a group contract). If the Subscriber is the patient, the relationship is SELF. If the Subscriber’s wife or husband is the patient, the relationship is SPOUSE. To assist in promptly handling the Member’s Claims, the Member must be sure that:
CHANGING FAMILY MEMBERS. ON THE MEMBER’S PLAN The Schedule of Eligibility lets the You know when You may add additional family members to the Your policy. Please read the Schedule of Eligibility and this section as they contain important information for the Member. If Your coverage was purchased On-Exchange: You will need to make all policy changes directly through the Exchange. If Your coverage was purchased Off-Exchange through an agent or through Blue Cross and Blue Shield of Louisiana: You will need to make all policy changes through the agent or through Blue Cross and Blue Shield of Louisiana. An Employee / Enrollment Change Form is the document that We must receive in order to enroll family members not listed on the Member’s original application/enrollment form. Because the Member is covered under a Group insurance contract, it is extremely important that the Member follow the timing rules in the Schedule of Eligibility for making these changes to the Member’s policy. If the Member does not complete and return a required an Employee / Enrollment Change Form to Us so We receive it within the timeframes set out in the Schedule of Eligibility, it is possible that the Member’s insurance coverage will not be expanded to include the additional family members. Completing and returning an Employee / Enrollment Change Form is especially important when the Member’s first Dependent becomes eligible for coverage or when the Member no longer has any eligible Dependents.
CHANGING FAMILY MEMBERS. ON THE MEMBER’S PLAN The Schedule of Eligibility lets the You know when You may add additional family members to the Your policy. Please read the Schedule of Eligibility and this section as they contain important information for the Member.
