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Retroactivity and Timeliness Issues
To ensure consistency and adherence to N. C. General Statute 135 Article 3 A, Section 125 of the Internal Revenue Code, and the Public Health Service Act, it is important that all transactions for enrolling newly eligible dependents and the processing of terminations are completed in a timely manner.
For detailed information on the requirements for enrolling newly eligible dependents, please review the "Adding and Removing a Dependent" section on page 50 in the Benefits Booklet that is available on the State Health Plan website at http://www.shpnc.org/sc-benefits-booklet.html.
Untimely termination notifications are costly, and can be very inconvenient to members, especially if claims have been paid beyond the eligibility date. The Public Health Service Act that governs continuation of coverage under government-sponsored group health plans requires that employers notify the plan administrator within 30 days of a qualifying life event, such as a termination. The plan administrator has 14 days to send the COBRA notice to the member.
Please note: The State Health Plan is closely monitoring all retroactivity. The health benefits representative must state in writing the reason why the transaction wasn't processed within the appropriate timeframe when the request is submitted to Blue Cross Blue Shield of North Carolina.
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