We are all aware of how important it is to have adequate health care coverage – and how expensive paying for health care can be. What participants may not know is that The New England Health Care Employees Welfare Fund (NEHC) is self-insured, which means health claims are paid by NEHC, not an outside insurance company.
NEHC has a responsibility to keep coverage costs down so we can maintain a competitive health care plan. That includes making certain that only dependents who are actually eligible are being provided with NEHC’s coverage. Insuring those who are not eligible raises our cost for health coverage.
In an effort to ensure that all of us are paying only for eligible dependents, we are implementing a dependent verification review through an experienced third-party firm. HMS, a highly recommended independent review firm, will conduct a confidential dependent verification process beginning in June 2018. HMS is known for their professionalism, confidentiality and sensitivity to participant needs and concerns.
We are confident this process will ensure that only eligible dependents are covered by NEHC – which means all of us are using, and paying for, insurance coverage fairly and accurately.
Who is eligible as a dependent? The NEHC benefit plan defines a dependent as your legal spouse and dependent children under the age of 26.
Who is not eligible for coverage under NEHC’s plan? A grandchild, a neighbor or friend, a roommate, a sibling, a parent or an ex-spouse are some examples of ineligible dependents.
Please note – if you do not cover dependents on an NEHC Health Care Plan, you will not receive notification from HMS.
What Happens Next?
- If you have dependents enrolled in an NEHC Health Care Plan, you will receive a letter addressed to your home in June, 2018 from HMS. The letter goes over the steps, information required, and response deadline to maintain coverage on your enrolled dependents. You will also be asked to submit evidence of eligibility directly to HMS, and will receive a postage paid reply envelope for your convenience.
Your action is REQUIRED even though you may have previously provided evidence of eligibility to NEHC.
- When you receive any correspondence from HMS, please read it carefully as there are specific due dates when certain information needs to be returned. Failure to follow the instructions could result in disruption of coverage for your eligible dependents.
- If HMS does not receive a response from you, even if all of your dependents are eligible for coverage, your enrolled dependents will be removed from the plan. You must respond to HMS and verify eligibility to continue health coverage for your dependents.
- Once HMS receives your proof of eligibility, a confirmation postcard will be mailed to you.
Detailed eligibility information, as well as a toll-free customer service number, fax number and customized web address will be included in the upcoming correspondence from HMS. Feel free to contact them if you have any questions or need additional information.
Thank you for helping to manage our Health Plan expenses, and for your continued compliance with NEHC’s health care plan guidelines and requirements. Your enrollment of only eligible dependents allows us to provide health care for all covered NEHC participants and their families