Employer FAQs
Membership
Physicians
Enrollment
Emergencies
Membership
When do enrolled employees receive their CDPHP member handbooks, ID cards, and contracts?
New CDPHP members should receive ID cards within two to three weeks after the processing of their enrollment applications. A member handbook, contract, and other helpful materials will arrive later under separate cover.
When is an employee or dependent eligible to join CDPHP?
In order to enroll in CDPHP, group members must meet certain eligibility criteria. These rules are spelled out in your contract. Generally, employees may join upon completing their waiting period or during open enrollment. Eligible employees and their dependents are also welcome to enroll or change their CDPHP coverage when their lives are affected by what is known as a "qualifying event".
What life changes are considered qualifying events?
Qualifying events include the following situations that can either make a person eligible for an off-cycle enrollment, or cause them to become ineligible for coverage:
- Change in legal marital status, including marriage, divorce, or the death of spouse.
- Addition of a dependent due to birth or adoption.
- Change in employment status of the employee or his or her spouse.
- A student dependent ceases to qualify due to age or completion of studies.
- The employee or dependent changes his or her place of residence.
Note: When an employee or dependent joins CDPHP following the termination of other coverage, a HIPAA certificate of creditable coverage should be submitted.
Are pre-existing conditions covered?
CDPHP does not impose any pre-existing condition clauses for commercial HMO group contracts. The PPO, EPO, and POS contracts do include a pre-existing conditions clause that pertains to members who previously did not have any coverage. Groups of 51 or more may waive the clause by means of a rider. Ask your marketing representative for details. Healthy New York contracts are also subject to a pre-existing conditions clause.
How does a member notify CDPHP of a change in address or last name?
Members may call the CDPHP Member Services Department at the number on their ID card to report such changes. Changes in address may be registered by the employee through the self-service portal, but a name change is not one of the functions that can be completed online. Employers may call Group Services at 1-866-258-1785 or (518) 641-3900.
Where does a member injured on the job or in a car accident file a claim?
Members injured on the job should submit claims to their Workers' Compensation carrier. For auto injuries, members should submit claims to their automobile insurance carrier.
Physicians
Will CDPHP recruit personal physicians upon request?
If a member's personal physician is not currently affiliated with CDPHP but is interested in joining, the physician should contact the CDPHP Credentialing Department. Whether or not the physician is accepted into the CDPHP network will depend on various criteria, such as meeting the CDPHP credentialing standards.
How do my employees change primary care physicians or OB/GYNs?
Members may change primary care physicians or OB/GYNs at any time by logging into the self-service portal and indicating their choice. Members may also call our Member Services Department to make such changes.
What if a member would like to see a non-participating practitioner?
Under CDPHP's HMO and EPO coverage, out-of-network care is not covered, unless CDPHP's medical director pre-approves services. With a POS or PPO plan from CDPHP Universal Benefits, Inc., members retain the right to seek out-of-network care.
How long is a referral/authorization to a specialist valid?
A primary care physician can write a referral/authorization for a specific number of visits or leave it open-ended, depending on the member’s medical needs.
Enrollment
How can a CDPHP account representative assist my business?
It’s important that your employees understand the fundamental differences between CDPHP coverage and other insurance plans. An account representative can answer your employees’ questions and explain what sets us apart from other plans.
How can I confirm enrolled employees?
Check your monthly bill from CDPHP to verify that every employee who submitted an Enrollment Application/Change Form appears under the appropriate contract type (single or family). If there are any discrepancies, notify the CDPHP Group Services Unit at 1-866-258-1785 or (518) 641-3900.
Completed Enrollment Application/Change Forms received by CDPHP within 30 days of the effective date of coverage and prior to the 10th of the month should appear on your next bill. You should review every monthly statement to confirm requested corrections and changes. If further corrections are required, call the CDPHP Group Services Unit at 1-866-258-1785 or (518) 641-3900.
Emergencies
What if the member is out of the service area and an emergency occurs?
CDPHP members have worldwide emergency coverage. If a true emergency occurs out of the service area, the member should go to the nearest emergency room and seek treatment, and contact his or her primary care physician within 48 hours.
If the member is out of the CDPHP service area and has to pay for services at the time of treatment, he or she should forward the medical records, an itemized bill, and proof of payment to CDPHP for reimbursement.
What if a member requires urgent medical attention but the situation is not a true medical emergency?
The member should contact his or her primary care physician (PCP) for care or advice. The PCP or another covering physician is required to be available at all times. Alternatively, the member may go to a CDPHP-participating urgent care center. These facilities are open evenings, weekends, and most holidays. A listing of urgent care centers may be found in Find-a-Doc.