In most cases, Corporate employees should be referred to their employer’s benefits department for enrollment materials. However, some groups have different rules. CSRs should refer to the TRICARE Corporate Groups Manual (OEP manual) to determine whether or not a group has special handling.
To locate the OEP manual (Open Enrollment Period)
Located your Tricare Shortcuts on your desktop, double click it to open. Double click on Tricare Supp -- OEP Groups - Shortcuts. Click on "Read Only"
If the OEP manual (Tricare corporate groups manual) states:
Enrollment Type |
Enroll with employer |
The EE (employee) must speak with their HR department & if there are any questions regarding premium or payments please refer the EE (employee) back to their HR department.
In some cases, the CSR will be able to provide enrollment forms to the Corporate caller. When this is the case, the CSR can find the enrollment form in W:\Fulfillment Materials\TRICARE\Corporate.
CSRs have a desktop shortcut to this folder.
Some groups ask that we never refer employees back to the employer for enrollment materials. All groups with special handling are listed in OEP manual the TRICARE Corporate Groups Manual.
There are two that most popular, they are General Dynamics and Mantech. I may refer to them as GDMAN, as a reminder.
During Open Enrollment Season, employers may refer their employees to a microsite that has been created by Selman & Company. If needed, CSRs can view the site by using this list of Corporate microsites. Located in the OEP manual.
State availability for Corporate business is based on the group’s state, not the employee’s state. Account Management ensures the group is eligible, based on their state. If the group is eligible (i.e., a client of ours), then no state restrictions apply to the employees.
Corporate insureds who live overseas may enroll. There are no restrictions in this regard.
EMPLOYEE SWITCHING EMPLOYER GROUPS
When an insured switches an employer group we will need to check a few items.
First check to see if the notes have been added to Inspro to terminate the current ER group. It should say something like.
Terminate due to ER rule 01/01/2010.
Then ask the insured who the new employer group will be.
Using the OEP manual determine how the new ER group enrolls. For example.
If the new ER group is file feed enrollment, you will need to check Imagenow to determine if we have the new enrollment request from the new ER group.
If we do not have the new enrollment request. Please reassure the customer that this process can take up to 90 business days. Reassure the EE that the file feed will arrive and we will complete the new enrollment. Please encourage the insured to seek all medical needs required.
Remember, the new effective date is determined by the new ER group.
The current Inspro policy will not lapse because the ER group rule.
If the insured states that is has been greater than 45 days since the ER group sent the file feed to us. Please send your email to our client management team. Ron, Twanna and CC Yolonda.
Please explain the EE has called to inquire when their new policy will be created with the new ER group.
Please set clear expectation with the EE not to send any premium to us until the new policy has been set up. This applies to when the EE will have a DB with us.