Policy/Memo 1r1

Number: Policy Memo 1r1
Date Issued: November 4, 1986
Date Revised: May 11, 2018
Policy File Ref: A200
Subject: Agency Requests for Administrative Exceptions

PURPOSE:

Establish guidelines for the review of agency requests for exceptions to computer assigned effective dates.

Background:

It sometimes happens that an employee will request a change in health insurance coverage which is not properly executed. The system properly assigns an effective date based on the information entered, but that effective date is incorrect based on program rules. The agency then requests an administrative exception to the assigned date. Typical situations resulting in such a request are the untimely processing of a request, misplaced or lost forms, submission of an incorrect transaction code, and failure to follow up on rejected transactions. In most cases, there is some physical evidence to support the agency's request.

Policy:

In cases where there is physical evidence to support the request the Employee Benefits Division will examine this evidence and determine the effective date of coverage based on program rules. Examples include a signed and dated form which was properly submitted to the HBA, or clear evidence of communications between the enrollee and HBA (such as copies of email communications).

In cases where there is no physical evidence to support the agency requests for an exception, we will require a signed statement from the agency HBA or personnel office staff who received the original employee request.