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

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I I I I PHP Group Administrators November 15, 1982 Page 2 4. PHP Coveraqe under Two PHP Contracts for the Same Individua~ We now allow PHP members to be covered as the subscriber under one PHP Contract and as the dependent under another. We will coordinate bene- fits between the two PHP Contracts in the same way that we would coor- dinate any two carriers. 5. Off-Cycle Enrollment after a Layoff or Strike Two new policies affect our enrollment procedures and requirements for employees who are returning to work after a strike or layoff. The first policy allows the re-enrollment of PHP members or dependents who were forced to drop PHP coverage because of layoff or strike, but who wish to return themselves ~or their dependents to PHP coverage following their return to active employment. The second policy allows the initial en~ rollment, outside of an open enrollment period, for spouses and other dependents who have lost other health coverage due to a strike or layoff: A. Re-enrollment of PHP members after a strike of layoff: If a PHP mem- ber is forced by a strike or layoff to drop coverage for self or depend- ents, re-enrollment will be allowed outside of open enrollment periods. No Evidence of Insurability will be required for members who terminate their coverage by PHP because of the strike of layoff. These returning PHP members will be issued new member numbers and cards, but the deter- mination of their 12-month liability for pre-existing condition limit- ations will be based on their date of initial enrollment with PHP, rather than on their date of re-enrollment. Only previously enrolled dependents and members are eligible for this waiver of pre-existing condition and insurability requirements. B. Initial enrollment of dependents who have lost health coverage due to strike or layoff: PHP members' spouses and other dependents who have lost non-PHP health coverage because of a layoff or strike where they work may be enrolled under PHP members' coverage outside of open enrollment periods. The new enrollees will be required to submit a com- pleted Evidence of Insurability form and a letter from their former em- ployer explaining the reason for their loss of health coverage. These new enrollees will be accepted at the discretion of PHP and will be li- Iable for pre-existing cOndition limitations the same as any new member. The effective date of coverage for these new enrollees will be the first of the month following the date of approval by PHP. I I hope these explanations are helpful. If you have any questions, please contact your service representative at 936-1200. i I