Agenda - Council - 12/21/1982 - Laserfiche WebLink

Home

I ,I I I I I I Physicians Health Plan OF MI~4~[SOTA A HEALTH MAINTENANCE ORGANIZA'I1ON 500 Opus Center 9900 Bren Road Easl Minnetonka. MN 55343 [~2) 936-1200 November 15, 1982 To Ail PHP Group Administrators CLARIFICATION OF SEVERAL PHP POLICIES To assist you in administering your Physicians Health Plan Group Con- tract, we have prepared the following brief explanation of several pol- icies that may affect your emplOyees. If you have questions about these explanations, please call your service representative at 936-1200. I I I I 1. Coveraqe for the Divorced Spouse of an Enrollee We now allow the divorced spouse of a PHP. enrollee to remain on the Plan until one or the other of the divorced PHP members, remarries. Coverage terminates automatically on the date of this remarriage. This continu- ation of benefits applies only to divorced spouses who were members of the Plan before the divorce; new enrollment of .a divorced spouse is not allowed. 2. Student Dependent Status We have simplified our documentation for student dependent status. We now require enrollees whose dependents are within 60 days of the lim- iting age to provide us with a signed "Certification of Dependent Stat- us." This form is printed on two-part carbonless paper; the enrollee can sign it, keep the second copy, and return the original to us. The signed Certification of Dependent Status shall satisfy the re- quirement that evidence of student status be provided to PHP. The mem- ber will not be required 'to send annual documentation of student status, but PHP does reserve the right to request further documentation of stu- dent status at any time. It will be the responsibility of the member to notify PHP if the dependent's student and employment status should change. " 3. Out of Area Waivers When reasonable, PHP will allow enrollees and their dependents to retain PHP coverage even if they move out of our service area. Each request for an out of area waiver will be reviewed by PHP. "Temporary Out of Area" waivers, will be granted to enrollees who move too far out of the PHP service area to be considered reasonable. This waiver permits the enrollee to retain PHP coverage until the next I I I open enrollment only. Enrollees who are granted these waivers must use PHP providers ex- cept in true medical emergencies. Both waivers must be approved in ad- vance and in writing by PHP management.