Policy/Memo 56

Number: Policy Memo 56
Date Issued: January 17, 1992
Policy File Ref: A220
Subject: Approving an Option Change Outside of the Annual Option Change Period

PURPOSE:

Expand the reasons for approving an option change outside of the annual option change period.

Background:

Recently the Dept. of Health changed its policy and now allows a person to enroll in an HMO if the person works within the HMO's service area. Previously a person had to reside within the service area. Since employees will now be permitted to enroll where they work, some may request option changes when a change in employment occurs.

Policy:

The following page provides a list of current exceptions and the new additions.

New Additional Circumstances:

• The enrollee has a job change and wishes to change to an HMO that was not previously available where he or she last worked or resides.
• The enrollee's job changes out of an HMO's service area in which he or she is enrolled.
• The enrollee retires and does not live in the HMO's service area but was enrolled in the HMO because he or she had worked in the HMO's service area.