The Prior Authorization Transparency Act amendment of 2017 impacted how subscribers or members may be terminated from group plans. Please review our guidelines below.
Termination Guidelines
- For an effective date of the last day of the month, employers have 10 calendar days after the last day to send in termination requests.
- For termination requests received within those 10 days:
- If there have been no medical or pharmacy claims, UM authorizations or benefit inquiries since the last day of the month, the request will be processed as requested, with an effective date of the last day of the prior month. Example: A request received on February 5 for a termination date of January 31 will be processed for an effective date of January 31.
- If medical or pharmacy claims, UM authorizations or benefit inquiries have occurred during the10-day grace period, the termination will be processed for the last day of the current month. Example: A request received on February 5 for a termination date of January 31 will be processed for an effective date of February 28.
- Requests received more than 10 days after the last day of the prior month will be processed for the last day of the month in which they are received.
- Future termination requests will be processed for the requested termination date. Example: A request received on February 14 for a termination date of February 28 will be processed for an effective date of February 28.
Resources
Complete the Termination Form to terminate a subscriber or dependent’s coverage. The form must be signed by the Group Administrator. Mail, fax or email the form as indicated.
To add, change or update a member’s status, please submit a Change Form.
Enter or update eligibility information easily via the QualChoice.com My Account portal. Get started here.
