It is extremely important that group administrators audit their health plan premium billing statements or carrier online eligibility rosters as frequently as possible. Carriers are contractually obligated to retroactively terminate or add eligible members only within a certain timeframe. Timeframes may vary but typically carriers will allow retroactive enrollment within 31 days of the date first eligible and will terminate up to 60 days retroactive to the intended date of termination.
Recent legislation contained in the Affordable Care Act will make it less likely that health insurance carriers will be willing to approve retroactive termination or enrollment exceptions.
Team BIM recommends that group administrators track their monthly new enrollments and terminations requested of the carrier and create a system in which they validate on the next premium billing that these transactions have been processed and the billing is correct. Checking eligibility every other month will help to ensure that the group avoids situations in which ineligible employees remain on the premium billing and that eligible employees do not go without coverage.
Although it is imperative that group administrators have a system in place to audit their enrollment changes frequently, we also recommend a full eligibility audit of a group’s premium bill or carrier enrollment roster on a quarterly basis if possible.
If you need assistance on recommended methods of auditing eligibility, please contact your Team BIM Client Service Manager.