Employers have so many different options available to them to utilize when sending their enrollment data to Diversified Group (i.e. payroll, HRIS systems, etc.). To make sure we are doing the best job for you, Diversified is making changes to our policies and procedures surrounding eligibility documentation to ensure that we are meeting your needs and avoiding duplication of efforts with the vendor you may use when sending enrollment data to Diversified. Our most important concern is being a good partner to you and your employees. As always, we are here to speak with you should you have any questions about these changes.
Effective February 1, 2024, Diversified Group (d/b/a Diversified Administration Corporation) will no longer be requesting the following enrollment/eligibility documentation:
- Marriage Certificates
- Birth Certificates
- Adoption Papers
- Divorce Decree (Groups that cover Divorced Spouses)
- Paper Enrollment Forms – we will no longer require hardcopies, nor will we be maintaining them on file after February 1st*
- Digital Enrollment Proof
- Documentation of HIPAA special enrollment right regarding loss of coverage – proof of coverage loss and date of coverage loss
- Documentation of HIPAA special enrollment right regarding adding a spouse or dependent outside of open enrollment – proof of marriage or birth
- Legal name changes – court documentation
- Removing a spouse due to divorce – divorce decree or court documentation indicating the date of dissolution of marriage
- Adoption – adoption papers for a new adoption
*If you are a group that exclusively uses paper enrollment and is not sending an outside enrollment file OR using our CEEM enrollment system, we will still accept the enrollment form to enroll members; however, you will want to maintain copies as we will no longer be maintaining copies of enrollment forms at Diversified.
Employers have the responsibility to ask for documentation from members as part of the operation of the health insurance plan. Although Diversified will no longer require copies of documents from you, in a self-funded health plan, management of eligibility is the fiduciary responsibility of the employer/plan sponsor. We would advise that the safest approach from a HIPAA Privacy perspective would be to maintain any documentation in a secure file separate from the employee’s personnel file. Please note, that should one of your members incur a stop loss claim, the stop loss carrier does have the right to ask for proof of enrollment and eligibility and you may be required at that time to obtain this documentation, thus the importance of maintaining document files as part of your health plan management.
Diversified Group takes the management of eligibility seriously because incorrect participant information can lead to overbilling, claim payment errors, or over-obligate the plan (for example offering COBRA to a member who wasn’t technically eligible). This process change is the result of feedback we have received from our client partners concerning our current practice. As such, beginning on February 1st, we will accept enrollment information submitted by the employer/plan sponsor and operate on the assumption that data submitted meets the plan’s eligibility criteria and has been verified by the employer/plan sponsor.
If you use an outside enrollment vendor and/or payroll service to send enrollment files to Diversified, you will receive a hold harmless agreement that will need to be signed within the next few weeks.
Even though we will no longer be requesting this specific data, Diversified Group’s eligibility team will always be available to assist you with any questions or concerns you have surrounding eligible members on your plan. Additionally, Diversified’s employer portal/enrollment system (powered by CEEM) is a robust enrollment option that will directly upload your plan’s enrollment data to Diversified. Please contact your Account Executive if you are interested in learning more about Diversified’s online enrollment solution.
Your Diversified Group team is always available to assist you with any eligibility questions or concerns and we encourage you to reach out to your account executive, eligibility representative, or our compliance team whenever you need guidance.
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