Scenario: Coverage Start Date

This page describes the specific circumstances in which Ideon expects to receive an updated plan effective date.

Employment Changes

• Apart from annual re-enrollment, employment events can set a new benefit start date for a given product line.

• Events in which the benefit start date could change due to a gap in employment:

  • Re-hire

  • Return from absence

  • COBRA

    • If a member is electing cobra coverages, please provide a termination of employment event, and then a cobra election event with a new benefit start date.

Please provide an incremented start date that corresponds with the new hire date and waiting period (if applicable) for that product line.

Eligibility Changes

• If a change occurs to the elements that first qualified a member for coverage, a new benefit start date will likely be required.

• If you have information that a member's premium is changing, a new benefit start date is likely required and should be provided on the transmission.

  • Carriers require these changes to reduce processing issues with Claims, particularly those made retroactively or across a given plan year.

• Based on plan design, a member's premium and electable plan options might change when one or more of the following elements are updated:

  • Residential Address

  • Work Location

  • Hours-per -Week

    • Changing from Full-time to Part-time

  • Compensation

    • Hourly -> Salary

      • Salary -> Hourly

  • Coverage Level

    • A family's coverage level (Employee-Only, Employee+Spouse)

Classification Changes

• If a member changes to a new employment classification within the same employer, it can mean new electable options, or effective dates. This is highly policy-specific.

To avoid a multitude of carrier rules, please provide the most recent effective date for a classification change on each Employment Classification per member.

Ideon can then use the employment classification date on the member to update their effective date on the Carrier transmission

Plan Changes

• When a member elects a new benefit option within the same product line, please provide a new benefit start date.

  • If a plan change happens mid-year due to a mistaken election, please provide an end-date for the current coverage election, and the same effective date for the coverage.

  • If a valid plan change happens mid-year, please provide an end-date for the current coverage election, and the new effective date for the product line.

Benefit Amount Changes

• For products that require a volume amount, a new approved volume amount is often a reason to increment the plan amount.

Please provide an incremented start date that corresponds with the approval of that new benefit amount.

Future Improvements

• Ideon is formulating a new field original_start_date that would allow a platform system to transmit both a most recent and original effective date to Ideon per election

Please contact Ideon Product for more information about this addition