All member changes, additions and deletions must be made using an HPS enrollment/change form. This form must be completed, signed and submitted to the Member Services Department.
* Note: The Medicare Part D Creditable Coverage Letter is a sample Microsoft Word document that you may use as a template or guide.
All enrollment and change forms can be faxed to 706-549-8004 or mailed to:
Member Services
Health Plan Select
295 W. Clayton Street
Athens, GA 30601
Use an enrollment/change form for all the following situations:
- Adding a new dependent
- Removing a dependent
- Change of name, address, phone number
- Electing continuation coverage
- Changing Primary Care Physician
- Termination of coverage
- Employee transferring from one company location to another
- Plan change
- Coverage tier change
- Consumer Choice Option is selected or dropped
Enrollments and changes must be received before the 15 th day of any given month (billing cut-off) in order for the change to appear on the monthly premium statement for that month. If changes are not received by the 15 th of the month they will appear on the following month’s bill.
The enrollment/change form may be faxed or mailed to our office. A maximum of two months retroactive credit will be given on disenrollments.
It’s important to let us know immediately when coverage should be terminated
for an employee or for a covered employee’s dependent. Timely notification of termination is critical so that HPS can issue the required documents to terminate members so they can make important decisions related to extending coverage or enrolling with another employer plan.
Please notify HPS within 30 days of the date the member ceases to be an eligible employee or any dependents who are terminating coverage by completing a change form.
Please be sure to include the following information when completing the change form:
- Employee’s name
- Group ID- found on your bill or on any member ID card
- Section B should be completed in it’s entirety to include
- date of employee or dependent termination
- reason for coverage termination
- date of change
- Section D- please indicate if member wishes to elect GA 90-day Continuation of Coverage or COBRA Continuation of Coverage.
- Employee signature is only required for termination of a dependent’s coverage or if they elect to continue coverage
- Employee signature is always required
Coverage may terminate due to the following examples, or for other reasons, as defined in the Evidence of Coverage.
- Employee ceases to meet HPS’ guidelines for eligible employees
- Employee chooses another health plan during open enrollment
- Employment is terminated
- A dependent reaches the maximum age for coverage
- A divorce
- A death
- A dependent child is no longer a full time student
- A dependent child is no longer handicapped or disabled
- A dependent child gets married
All terminated employees are covered through the end of the termination month.
Your group bill provides you with much more information than just the amount your company owes for employee coverage. We ask that you take time each month to perform an audit of your employees to ensure the coverage you are being billed for is correct. Remember that any changes made on your groups enrollment made after the 15 th of the month will be adjusted on the premium billing on the following month.
Monthly Premium Billing Statements are sent two weeks before the end of the month prior to the effective date. Your premium is due on or before the first day of the month for which covered services are to be provided.
Promptly remit payment to: Health Plan Select
P. O. Box 7336
Athens, GA 30604
Retroactive credits will only be given for a two-month period following termination. HPS will not go back more than two months when issuing credits for termination.
HPS will bill a full month’s contribution for members terminating during the month. Since any terminated employee is covered through the end of the month in which they terminate, no adjustments/refunds will be made as a result of a termination.
Your group will also be charged a full month’s premium for all additions effective as of the fifteenth of the month. A half-month’s premium will be charged for members added between the sixteenth and the twenty-ninth of the month. Members added on the thirtieth or thirty-first at no cost.
If coverage is terminated for non-payment of premiums, the employer group will be responsible for repayment of all charges for services and supplies received by their employees following the termination effective date.
Georgia Law (90 Day Continuation)
Regarding companies with less than 20 employees
An employee who has been covered for at least six months and has lost coverage due to termination of employment can extend coverage for himself/herself and any covered dependents for up to three months. The Policyholder must collect 100% of the premium from the member and submit it along with the regular monthly premium payment. The member may be put into a separate sub-group to simplify tracking if this has been previously arranged with HPS.
Continuation of Coverage must be requested in writing and the employee must pay the first month’s premium and any retroactive premium charges for Continuation of Coverage to the employer within thirty‑one (31) days after the date the coverage ends.
A Change Form must be submitted indicating a terminated employee has elected the 90-Day Continuation. If a member decides to elect only a portion of the 90 days or if a member is no longer eligible for this continuation, submit a change form to terminate all coverage.
QUESTION: My company has less than 20 employees and will be canceling all of the health insurance coverage for the company. Will our employees be eligible for Georgia Continuation?
ANSWER: No. Since the plan is being completely cancelled there will be no coverage available. However, your employees may be eligible for conversion coverage. Please contact HPS for more information.
QUESTION: Does the Georgia Continuation coverage count as Creditable Coverage under the HIPAA regulations?
ANSWER: Yes. All Group and Individual policies count as Creditable Coverage.
QUESTION: How long are my terminated employees eligible for coverage under Georgia Continuation?
ANSWER: 3 months.
QUESTION: How are the premiums collected for Georgia Continuation?
ANSWER: The premium will be at the same rate as a member’s whose coverage has not been terminated and should include both the member’s premium contribution AND the employer's premium contribution. Premium payments must be made to the employer group. HPS will continue to the bill the employer group for the applicable premium for any employees electing Georgia Continuation of Coverage. HPS DOES NOT bill your employees for this coverage.
