Educators Health Alliance Dependent Eligibility Verification Group Leader Orientation

Dependent Eligibility Verification (DEV) What is DEV? With the help of the workforce, Dependent Eligibility Verification is a process that reviews and confirms the eligible status of EHA’s family members A standard, consistent & defendable process that removes dependents from the medical and dental plan who do NOT meet the Plans guidelines for eligibility Educators Health Alliance Board of Directors has retained Xerox HR Solutions (Xerox) to execute this project DEV an EHA driven project... It is a shared pledge NOT just Educators Health Alliance Board of Directors launched this initiative to ensure effective compliance of qualified employees and their dependents

Who will be included in the verification? Populations to be reviewed Actives Direct Bill Retirees Plans included in the review Medical Dental Dependents to be verified Spouse Dependent Children November 12, 2018

Required Documentation Dependents to be verified Spouse Dependent Children Married Most Recent (documentation from Xerox will advise tax year accepted) Federal Tax Return (pages 1 and 2) Mark out all financial information OR Either State Issued Marriage Certificate (issued after marriage date) or Common Law Affidavit AND Proof of Joint Ownership (shows both names) Mortgage Statement Bank Statement Utility Bill Current lease or rental agreement (within 120 days of initial correspondence mailed date) Marriage Certificate Legally Separated or Divorced Court Documents Biological Birth Certificate Adopted Court Documents; Modified Birth Certificate Stepchild Stepchild (Spouse not on the plan) Birth Certificate showing spouse as parent AND Will also need to provide spouse documentation (see left-hand columns) Foster child; Legal Guardianship Court Documents November 12, 2018

What support is available to participants? Xerox HR Solutions Service Center Highlights 100% dedicated to Dependent Eligibility Verification Spanish speaking agents available Trained, experienced Service Center team members Standard training: HIPAA, ERISA, State and Federal regulatory guidelines (common law marriage etc.) EHA specific training: SPD Guidelines, documentation requirements, etc. Employee calls tracked using proprietary software (DADE) Detailed notes logged for all employee calls Recording of calls for dispute and appeal purposes Hours: Monday–Friday 8 a.m. to 8 p.m. and Saturday 9 a.m. to 2 p.m. ET. Helpline Number 1-855-874-8505 November 12, 2018

Example of An Audit Timeline *Members will receive similar time frames to complete audits – example below highlights dates that may apply to dependents added to coverage January-March Dependent Eligibility Verification May June July August Employee Correspondence 5/3 Pre-Announcement Postcard (Home Mailing) 6/24 Postmark Date for POE Materials 7/5 Removal Notices (Term Date will be 6/30) for Non-Responders (Home Mailing) 8/23 Appeals Process Ends (Approximately 60 days for appeals 6/24-8/23) 5/10 POE (Proof of Eligibility) Initial Notice – Dependent and Spouse Verification (Home Mailing) *Please note that dependents will not actually be termed from coverage until appeals period is exhausted, however, the termination date will be retroactive (in this example back to 6/30) 5/31 POE Reminder Notice (Home Mailing) *Participation Complete or Incomplete Response notice sent within 3-5 days of member response November 12, 2018

Additional FAQs Audits are performed on-going on a quarterly basis; eligibility files are sent to Xerox from BCBSNE which include dependents added to coverage January-March, April-June, July-September, & October-December If a dependent was missed on a previous audit, they may be picked up on a future audit – Example: Baby born on 3/31 and was not added to policy in time to be sent to Xerox on January-March file will be picked up on the next audit Xerox advises BCBSNE of which dependents did not complete their audit prior to appeal process. BCBSNE currently sends Group Leaders communication about which dependents will be termed. It is at the Group Leader’s discretion to reach out to affected individuals as a reminder Common causes of audit denials: State issued marriage certificate with issue date after marriage is required versus the marriage license which is issued pre-ceremony; Birth certificate is required versus hospital issued birth record BCBSNE Members Services & BCBSNE Group Account Teams are unable to view documentation received by Xerox so questions about a specific audit should be directed to Xerox HR Solutions Service Center at 1-855-874-8505 for further assistance November 12, 2018

Example of Audit Correspondence Envelope P.O. BOX 980 Maumee, OH 43537-9973 Eha_110612_Eg_#10 Mailing Envelope 11 08 12 9.25 Open Immediately — Dependent Eligibility Verification Information BARCODE AREA November 12, 2018