A two-sponsor family is one where both spouses are in the military and they both qualify for TRICARE.
A two sponsor family might have one joint/combined TRICARE plan or it might have two separate/individual TRICARE plans.
It is important that the number of TRICARE plans equals the number of SUPPLEMENT plans. If the numbers match, there will be no issue with claims.
However, if the numbers do not match, there could be problems with claims.
Certain things that accumulate during the plan year (deductibles, Catastrophic Caps, etc.), might not “match up” between our system and TRICARE’s system.
When needed, members can give us permission to either split or combine two supplement plans so that we mirror the number of TRICARE plans.
Or, if preferred, the members can instead ask TRICARE to either split or combine two TRICARE plans so that they mirror the number of supplement plans.
We need the member’s permission before we can combine or split two supplement plans. Combining or splitting policies can have side effects (changes to premium, changes to the number of deductibles, changes to how the Cat Cap is calculated, etc.).
Usually, the Claims Department will create a letter when they realize that claims are being affected. The letter explains that it is better to have a matching number of TRICARE plans and supplement plans. The letter will suggest that the members make changes either to the supplement arrangement or to the arrangement with TRICARE. These letters are created by Rose’s team and then emailed to Customer Service so that a CSR can mail the letter along with the needed enrollment forms.
If the member decides to split or combine policies with us, Claims will send the member’s request to Enrollment. Enrollment will work with Billing to make the changes needed to the InsPro records.
These changes should coincide with the beginning of the plan year. This usually means we must make the change retroactively in our system.
Billing must also split or combine the premiums paid for that same plan year.
Once the changes are complete and the plan(s) are paid up as far as possible, Billing should notify Claims so that affected claims can be reprocessed.
To correct the policies please ask the insured which of the two policies will be terminated. Notify billingwork@selmanco.com to terminate the policy effective the first of the following month. **Make sure the paid to dates are current. If not, advise the insured you will need the back premium paid.
Then you will also advise billing work flow to add those insureds from the terminated policy to the active (A01) policy because this is two sponsor family.
Once billing notifies you this is complete. You will have to notify claims the family is now under one Emerge ID number XXXXXX and to move all accumulation from the terminated policy to the active policy.
See this section, What is the Catastrophic Cap?