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BLUE CROSS Group Administrator Website User Guide

1. Page 113 of 128 Services Updates L HELP 4 LOGOUT x mj dh BLUE CROSS n a Poucies Members Partics ie Search General Member Selection Coverages Request in ID Activity Details Details Updates Within the Services Updates tab the user will be able to View transactions that have been submitted current day will be processed overnight Delete transactions that are to be processed overnight on the employee s file View transactions that have been submitted but are to be processed in sequence over more than one business day Note Users with inquiry only access will only be able to view the above information BY ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross File Edit wiew Favorites Tools Help Eo MAIL HELP LOGOUT dh BLUE CROSS WELCOME PRIVACY E M Soi z rcs SESS vs UUU Search General Member Selection Coverages Request ID Activity Details Updates Policy ID 12345 Division 000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 600293426 Member Updates Userld Date Description WebGA O3Dec2006 Insured Details Query Delete Done z a al Local intral Page 114 of 128 Services Updates continued Member Updates Any changes that have been submitted will be displayed in a summary form in the Services Updates tab The User ID of the person who
2. File Edit view Favorites Tools Help e ri a el 4g bad n dh BLUE CROSS WELCOME PRIVACY E MAIL HELP LOGOUT Policies Members Parties A Search General Coverages Services Packages Policy ID 12345 Division J000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293426 Member Add Package Package Choices Health Coverage Options Life Coverage Options I Medical M Life I Dental I Disability Effective Date 1 Dec y 2006 List Available Packages Current Employee Classes Packages Medical AA MEDICAL PACKAGE 1 Family Eff Date 01Sep2003 4 Hospital F Travel 45 Extended Health Benefits 10 Drugs Dental AA DENTAL PACKAGE 1 Family Eff Date 01Sep2003 6G Dental Life A ALL EMPLOYEES LIFE 1 Eff Date O1Jun2000 3 Rasir ife A ALLEMPLOYEES DEPENDENT LIFE 1 Eff Date O1Jul2004 3 Dependent Life A ALL EMPLOYEES CRITICAL CONDITION Eff Date 01May2005 C3 Critical Conditions Disability A ALL EMPLOYEES DISABILITY 1 Eff Date 01Mar2000 3 Short Term Disability Available Employee Classes Packages select a Life Coverage Option ALL EMPLOYEES OPTIONAL LIFE Optional 1 Optional Life Amount 20000 ALL EMPLOYEES OPTIONAL SPOUSE LIFE Optional 1 Optional Spouse Life Amount Claim Waiting Period Applied C Waived Late Applicant C Yes No Continue Cancel Delete CT Rg Loca intra Page 72 of 128 Member Se
3. Contribution Year 2006 Yearly Deposit 1000 Effective Date 31 Oct 2006 Continue Cancel Delete Dor LLB Ekana Alternate ID The Alternate ID fields are not mandatory but are presented as some clients require this information to be completed Typically if the Alternate ID is a mandatory field for the client then it would be presented on the initial screen of the enrolment and the number entered would be printed on the subscriber s identification card Occupation These fields will be presented when disability life benefits are selected There are thirteen choices with examples listed for each category To view the category the user should select All from the drop down menu The Occupation field allows the user to enter a more detailed description as it is a text field The occupation information affects the premiums and will affect the group rates at time of renewal Page 16 of 128 Member Add Member Details continued Salary These fields will be presented when life benefits are selected and are based on salary The fields are mandatory if presented and must be completed by the user Health Spending Account HSA If applicable the HSA information can be entered on this screen Check the box to the left of the HSA fields and then enter the contribution year initial HSA deposit amount and the effective date The HSA can be added or modified at a later date as well Click Continue to proceed to the next scr
4. General Member Selection Coverages Services Personal Data Package Choices Benefit Selection Member Details Insured Details Policy ID 12345 Division OOO COMPANY ABC Owner ABCC system ID 500293426 Main Division Atlantic Regional Group First Name Relationship Date of Birth Tammy Child 10 v Aug y 1986 Last Name Dependent Status Gender Privacy Consent Smith Regular gt Female gt Yes gt l Pre Register Student Select if eligible Continue Cancel Delete Dore LT d Local intra Page 20 of 128 Member Add Confirmation Once the information is submitted the last screen presented is the confirmation screen At this point if the information needs to be modified the user can go back to any of the tabs and modify the information The user can click on the Show Details button to view a summary of the informaton that has been entered If the information is complete click on Submit from the navigation bar to save the application If the user does not submit the information then the application will remain in an In Progress state until the user goes back into the ID and submits the request Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross File Edit wiew Favorites Tools Help 1O as dh BLUE CROSS ee p Potcies Mear Portics Search Personal Data Package Choices Benefit Selection Member Details Insured Details Confirm Policy ID 12345 Division 000 COMPANY ABC O
5. Member Selection Benefits dh BLUE CROSS WELCOME PRIVACY L HELP LOGOUT _ i a mpna Policies Members Parties EOE Search General Coverages Services Benefits Co ordination of Benefits HSA Within the Member Selection Benefits tab the user will be able to Add Update the coverage amounts for optional life benefits Add benefits packages Revise Terminate current benefits packages View a summary of benefits Note Users with inquiry only access will only be able to view the above information 3 ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross File Edit View Favorites Tools Help tr ee _ P dh BLUE CROSS WELCOME PRIVACY E MAIL HELP LoGour Me n emm Policies Members Parties E Search General Coverages Services Benefits HSA Policy ID 12345 Division 000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293428 Benefit Selections Medical C A amp A MEDICAL PACKAGE 1 Eff Dt EffTrans Dt Term Dt Term Trans Dt Rating Status Family 4 Hospital 010ct2006 17Nov2006 F Travel 010ct2006 17Nov2006 1 Extended Health Benefits 010ct2006 17Nov2006 5 Drugs 010ct2006 17Nov2006 Dental A amp A DENTAL PACKAGE 1 Eff Dt Eff Trans Dt Term Dt Term Trans Dt Rating Status Family 9 Dental 010ct2006 17Nov2006 Life A ALLEMPLOYEES LIFE Eff Dt Eff Trans Dt Term Dt Term Tra
6. AA DENTAL PACKAGE 1 Mandatory 9 Dental Health Care Province NB Rating Status Family gt Waive ry Waive Reason Select a Life Coverage Option Life A ALL EMPLOYEES LIFE Mandatory Waive O Waive Reason 3 Basic Life 1 Accidental Death amp Dismemberment M A ALL EMPLOYEES CRITICAL CONDITIONS Optional C3 Critical Conditions Amount 50000 Rating Status Family Disability A ALL EMPLOYEES DISABILITY Mandatory Waive O Waive Reason gt 3 Short Term Disability 30 Long Term Disability Continue Cancel Delete CL YL oana Page 12 of 128 Member Add Benefit Selection continued Package Options On the Benefit Selection tab the user will be presented with the package options that correlate to the package combination selected on the Package Choices screen They must select the radio button to the left of the appropriate package If the package options are not clear the names of the packages can be modified to provide clarity to the user Rating Status The Rating Status ex Single Couple or Family must be selected from the dropdown list If two different statuses are selected two different IDs will be created For example if Family is selected for health benefits and Single for dental benefits then two IDs will be created Family Health and Single Dental If there is an asterisk beside the status selection then the statuses must be the same for both Waiving the Benefit
7. Click Update to proceed to the next screen A ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross Fie Edit Yiew Favorites Tools Help ti dh BLUE cross WELCOME e i MAIL HELP LOGOUT a a il Poticies Members fPeO Search General Coverages Services Insureds Co ordination of Benefits Policy ID 12345 Division 000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293426 Insured List M Insured Status Eff Dt Eff Trans Date Term Dt Term Trans Dt Single 010ct2006 Tag Name Gender Date of Birth Age Eff Dt Term Dt T O00 JOHN SMITH Male O1Jan1970 36 01 0ct2006 Member VY O01 JANE SMITH Female O1Jan1970 010ct2006 30Sep2006 Spouse MW O02 JOHNNY SMITH Male 01Jun2005 010ct2006 305ep2006 Child Regular Add Insured Update Query EB CEEE E E Locate Page 55 of 128 Member Selection Insureds continued Changing to Family Status and Reinstating Participants continued Once Update has been selected from the previous screen the following will appear Select the appropriate status from the dropdown bar and indicate the effective date To reinstate the participants select the wording Day Month Year from the dropdown boxes in the Term Date field Click Save to process the changes 2 ABCC Enrollment Microsoft Internet Explorer provided by Medavyie Blue Cross Fie Edit view Favorites Tools Hel
8. Done 1 _ B E Local intr Page 105 of 128 Member Selection HSA continued Delete Health Spending Account HSA The user can select the radio button to the left of a contribution year and then click Delete to remove the information entirely It is not recommended for this option to be used It is preferable to use the Update function as outlined in the previous section J ABCC Enrollment Microsoft Internet Explorer provided by Medavyie Blue Cross Fie Edit Yiew Favorites Tools Help O e a gk BLUE CROSS WELCOME PRIVACY E M air me nt E Poticies Members Parties T SS Search General Coverages Services Co ordination of Benefits Policy ID 12345 Division 000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293428 Health Spending Account Are you sure you want to delete Contribution Year Current Balance Effective Date Te c 2005 12 01Mar2005 al YD 2006 12 01Jan2006 31 re you sure you wish to submit this as is cme Add Update Query Delete Opening page httos www atl bluecross cales Unifi Console uy3desianles en members selections u uhtml RESULT ID es en members ff E E A Local intra Page 106 of 128 Coverages Summary dh BLUE CROSS Policies Members Parties e Search General Member Selection Services Summary Within the Coverages Summary tab the user will be able to View current p
9. LOGOUT Poticies Members parties ERS ce TY General Coverages Services insureds Benefits Co ordination of Benefits HSA dh BLUE CROSS AEA UU Search General Member Selection Services Summary dh BLUE CROSS Search General Member Selection Coverages Request ID Page 24 of 128 General Miscellaneous dh BLUE CROSS WELCOME E MAIL s Policies Members Parties S S Search Member Selection Coverages Services Miscellaneous Membership Details Member Activity Within the General Miscellaneous tab the user will be able to Change Member Information Terminate Reinstate Coverage Note Users with inquiry only access will only be able to view the employee information on this tab p ABCC Enrollment Microsoft Internet Explorer provided by Medavyie Blue Cross a ce eee DE y EM AIL i sour ee BLUE CROSS WELCOME 4 PRIVA i Policies c aa Parties n Member Selection Coverages Miscellaneous Membership Details Member Activity Policy ID 12345 Division 000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 600293426 Miscellaneous Name JOHN SMITH Address 123 MAIN STREET ANYWHERE TOWN NB Postal Code Telephone Number 506 555 5555 Effective Date 010ct2006 Termination Date Paid to Date Termination Reason Policy Series Retention Group Language English Update Terminate Reinstate Qu
10. Blue Cross File Edit Yiew Favorites Tools Help _ gt F WELCOME PRIVACY E MAIL HELP LOGOUT a pn a z dh BLUE CROSS Policies Members Parties Search General Coverages Services Co ordination of Benefits sa Policy ID 12345 Division 000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Benefits Ext ID 500293428 JOHN SMITH 500293428 Benefit Selections Medical MEDICAL PACKAGE 1 Eff Dt Eff Trans Dt Term Dt Term Trans Dt Rating Status Family 4 Hospital O010ct2006 17Nov2006 F Travel 010ct2006 17Nov2006 1 Extended Health Benefits O10ct2006 17 Nov2006 5 Drugs 010ct2006 17Nov2006 Dental DENTAL PACKAGE 1 Eff Dt Eff Trans Dt Term Dt Term Trans Dt Rating Status Family 9 Dental O10ct2006 17Nov2006 Life ALL EMPLOYEES LIFE Eff Dt Eff Trans Dt Term Dt Term Trans Dt 3 Basic Life O10ct2006 17 Nov2006 1 Accidental Death amp Dismemberment O010ct2006 17Nov2006 a Cavaradaa Add Coverage Amount Update Coverage Amount Add Package Revise Package Terminate Package Query Done E al Local intranet Page 71 of 128 Member Selection Benefits continued Add Benefits continued Packages Is the first tab within the workflow The user is to select the benefit options enter the effective date of the change and then click the grey List Available Packages button 3 ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross
11. Diwision ooo Identification Murnber Last Name Smith First Name Jonn Book of Business E Display member list Policy ID B Division r 4 Add Member Clear Search Fields Query Page 22 of 128 Member Search continued Name Search Name searches can be done using the wildcard if the complete spelling is not Known or if there could possibly be initials used A minimum of three characters must be entered in the last name field The more information that is entered the more quickly the results will come back External ID Search The external ID is the number that is printed on the employee s identification card The majority of searches by ID number would be successful if this option were chosen Alternate ID Search The alternate ID number represents a number that is assigned to the employee by the group plan administrator when Blue Cross benefits are assigned This number is referred to as the Alternate ID when assigning benefits using this website It may be a payroll number or an employee number unique to the organization assigning the benefits This number is typically printed on the card as well and can be searched for using either the External ID or the Alternate ID options System ID Search The system ID number is a number assigned by Blue Cross It would appear on the identification card if an alternate ID number was not assigned by the organization providing benefits This numb
12. General Miscellaneous continued Reinstatement of Benefits continued Packages is the second screen presented in the workflow The benefits that the member had at the time of termination will be presented The user must re select the packages that the member had or the packages can be changed at this point The rating status must also be reselected or changed on this screen Click Continue once the selections have been made A ABCC Enrollment Microsoft Internet Explorer provided by Medayie Blue Cross Fie Edit View Favorites Tools Help dh BLUE CROSS WELCOME PRIVACY sll ronces Members Parties Search Member Selection Coverages Services Reinstate Transfers Packages Policy ID 12345 Division 000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 600293426 Ly HELP A cour Member Reinstate Package Choices Current Employee Classes Packages Medical AB MEDICAL PACKAGE 2 Single Ef Date 13Jul2000 4 Hospital F Travel 45 Extended Health Benefits R Drugs Dental AB DENTAL PACKAGE 2 Single Eff Date 13Jul2000 Ax Dental Life A ALL EMPLOYEES LIFE 1 Eff Date 13Jul2000 3 Basic Life Disability A ALL EMPLOYEES DISABILITY 1 Eff Date 13Jul2000 3 Short Term Disability Available Employee Classes Packages Pick all applicable coverages If not they will be cancelled Policy 12345 Division 000 Select a Health Coverage Option If packages hav
13. 100 of 128 Member Selection HSA dh BLUE CROSS WELCOME PRIVACY E MAIL HELP LoGour n morn Poticies Members parties S Search General Coverages Services Co ordination of Benefits Within the Member Selection Health Spending Account HSA tab the user will be able to Add HSA information Update Terminate HSA information View HSA information Note Users with inquiry only access will only be able to view the above information ze ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross File Edit wiew Favorites Tools Help ada dh BLUE cCROSS WELCOME PRIVACY E MAIL neip i LoGour PA Policies Members parties NS M Search General Coverages Services Co ordination of Benefits Policy ID 12345 Division J000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 5002934286 HSA Health Spending Account Contribution Year Current Balance Effective Date Term Date Forfeit Date c 2005 12 01 Mar2005 31Dec2005 26Feb2006 c 2006 12 01Jan2006 31Dec2006 28Feb2007 Add Update Query Delete Pme lll EE E E Local ita Page 101 of 128 Member Selection HSA continued Add Health Spending Account HSA To add HSA information for the new year the user would select the Member Selection HSA tab and click Add from the blue navigation bar on the bottom of the screen E ABCC Enrollm
14. 87 of 128 Member Selection Benefits continued Backdating Benefits continued Once the packages have been chosen the user is taken to the Insured Details tab where current information is displayed Additional insured can be added at this point by selecting the grey More Insureds button If changes are required to current information on file please refer to the section entitled Member Selections Insureds Modifying Insured Details Click Continue to proceed i ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross Fie Edit View Favorites Tools Help niu BLUE CROSS WELCOME PRIVACY E MAIL HELP LOGOUT Policies Members Parties services ee 3 Member Selection 3 Insured Details Policy ID 12345 Division 0009 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293428 Member Package Revision Insured Details First Name Relationship Date of Birth JOHN Member O01Jan2006 Last Name Gender Privacy Consent SMITH Male Yes First Name Relationship Date of Birth JANE Spouse O1Jan1970 Last Name Gender Privacy Consent SMITH Female Yes Marital Status Date First Name Relationship Date of Birth JOHNNY Child O1Jun2005 Last Name Dependent Status Gender Privacy Consent SMITH Regular Male Yes More Insureds Continue Cancel Delete Done rT T amp Local intra Page 88 of 128 Member Selection Benefits continued Backdating B
15. ID 500293426 JOHN SMITH 500293426 Member Transfers Effective Date fi y Dec y 2006 Policy 12345 Division ooa Continue Cancel Delete SF coat Page 42 of 128 General Member Activity continued Transfers continued Once the user has clicked the query button from the previous screen the following information will be presented The user is then able to change the province in which claims are to be adjudicated if required Click Continue from the navigation bar on the bottom of the screen E ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross Fie Edit View Favorites Tools Help i dh BLUE CROSS WELCOME PRIVACY E MAIL HELP LOGOUT Policies members Parties Search Member Selection Coverages Services Reinstate Transfers Policy ID 12345 Division 0009 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 00293428 Member Transfers Effective Date E Dec y 2006 Policy 12345 Division 001 Query Company Name COMPANY ABC Reason for Division Sub Division External ID 500293428 Health Care Province NB gt Continue Cancel Delete Done er zm he al Local intra Page 43 of 128 General Member Activity continued Transfers continued Once the user clicks Continue on the previous screen the current benefits that the employee has will be displayed If nothing is changing in terms o
16. ING Other Group Administrator Inquiries Page 125 of 128 The user will then be presented with a Welcome Page from which they need to select the Members option The Members tab will allow the user to access the Search function Ji BLUE CROSS Parties Welcome to Group Administrator Services Group Administrator Services gives you the opportunity to View policy lists to locate your specific policy Perform memberspecitic transactions such as adding a new member or dependent or changing address or benefits Perform member searches to locate a specific member of a policy and or view member information Once the Members tab has been selected a secondary navigation bar is presented To view existing eligibility the user must start with the Search tab ronces Members Poe General Member Selection Coverages Services Page 126 of 128 View Members Benefits and Personal Information To view an existing member s coverage or personal information the user must first open the member s file by using the Search function The user can search by identification number or name Once the search criteria are entered the user should click on Query from the blue navigation bar at the bottom of the screen They will be presented with a listing of all members matching the search information entered The user must then select the blue link to open the employee s file For more details on the types of searches that can b
17. If the benefit can be waived there will be a Waive Option and Waive Reason presented To waive the benefit check the Waive box and select a reason from the dropdown list Life Benefits Life Benefits are grouped together by class Select the appropriate class and click the radio button to the left of the class Optional benefits that are available in that class are displayed and must be selected by checking the appropriate box to the left of the benefit Click Continue to proceed to the next screen Page 13 of 128 Member Add Beneficiaries The Beneficiaries screen will be presented if the Life options selected require that a beneficiary be assigned Complete the name s and indicate the percentage to be assigned ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross Fie Edit wiew Favorites Tools Help X IIa dh BLUE CROSS WELCOME PRIVACY E MAIL HELP LOGOUT Poticies Members artic Ii Search Beneficiaries Policy ID 12345 Division D00 COMPANY ABC Owner ABCC system ID 500293426 Main Division Atlantic Regional Group Member Add Beneficiaries Last Name First Name Relationship Percentage Irrevocable Update Id Smith Jane Spouse 100 C PoE L Loo GOES SCO LU CL LY B Local intra oS Multiple Beneficiaries If there are multiple beneficiaries the percentages must add up to 100 The percentages must be assigned as whole values For example
18. Waiver of premiums yes 30 Long Term Disability Eligible Amount 3 612 Approved Amount 3 612 COLA no Definition of disability 60 60 Definition of plan 2 year own occupation Offset provision direct Pension supplement no Pre existing condition 3 6 12 Survivor benefits no Waiver of premiums yes Return Done Zz SS a al Local intra Page 109 of 128 Services Request ID Card E MA wey gt otis S vcs Search General Member Selection Coverages Request ID Activity Details updates Within the Services Request ID tab the user will be able to Request a new ID card View the last date a card was created Note Users with inquiry only access will only be able to view the above information A ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross File Edit view Favorites Tools Help G sack O x 2 A J search 5 Favorites OR w LJE 3 dh BLUE CROSS WELCOME PRIVACY E MAIL HEL LoGour a poticies Members Products Portics O Search General Member Selection Coverages Billing Request io Activity Details Details upactes Policy ID 12345 Division J000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 600293426 Services l Request Identification Card History of Card Generation Date Produced Source Reason 20Jul2006 System Generated Replacement Card O7Jul2006 Card Reque
19. affects information related to the rating status policy and division or the effective termination date of the plan the changes would be displayed here and could involve the transaction to be stacked Stacking will be displayed as Sequence 1 Sequence 2 etc where each sequence represents a different step that must be submitted on the system in that specific order For example Sequence 1 would be submitted on day 1 and must update before sequence 2 can be applied on day 2 If there are 3 sequences it will take 3 days for the work to be processed In some cases depending on the change cards will be produced the user may receive more than one card before the final card is issued Blue Cross is taking measures to eliminate the generation of multiple cards for this transaction ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross File Edit View Favorites Tools Help O M di BLUE CROSS ee A Poticies Members l fEfPa ieaO Services Request ID Activity Details updates Policy ID 12345 Division 000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293426 Activity Details Information on File Rating Empl Policy Diy Status Prov Class Eff Dt Eff Trans Dt Non Life Term Dt Life Term Dt Series 12345000 Family NB A 010ct2006 1 Nov2006 Retention Group Changes Requested None Query Delete Done E a Local intr
20. appropriate reason from the dropdown menu Click Continue to proceed into the workflow A ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross Fie Edit View Favorites Tools Help dh BLUE CROSS WELCOMEsjpePRIVACY E MAIL HELP 10GOUr PPa Policies members Parties Search General Packages Policy ID 12345 Division 0009 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 600293426 JOHN SMITH 500293426 Member Package Revision Package Choices Health Coverage Options Life Coverage Options M Medical v Life M Dental I Disability Health Care Province NB Effective Date E Oct v 2006 Replace Current Employee Classes Packages Medical AA HEALTH A FAMILY Family Eff Date O1Jan2002 F Travel TB Extended Health Benefits PX Drugs Dental AA DENTALA Family Eff Date O1Jan2002 XR Dental Life A ALL EMPLOYEES CRITICAL CONDITIONS 1 Eff Date 01Jan2005 C8 Critical Conditions Available Employee Classes Packages Select a Health Coverage Option If packages have rating status s marked with a they must have the same value C Medical AA HEALTH B FAMILY Mandatory SP Hospital Health Care Province NB Rating Status TD Extended Health Benefits Waive m Waive Reason o PX Drugs F Travel Dental AA DENTAL C Mandatory XT Dental Health Care Province NB Rating Status gt Waive Waive Reason Continue Cancel Delet
21. blue navigation bar on the bottom of the screen To determine the volume of coverage available click the grey Benefit Descriptions button to the right of the date field pT ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross File Edit View Favorites Tools Help O oe So dh BLUE CROSS WELCOME PRIVACY E MAIL HELP LOGOUT n Poticies Members Partics Coverages Summary Policy ID 12345 Division 000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293426 Date 1 Dec 2006 Policy ID 12345 Division 000 Coverage Summary represents benefit limitations JOHN SMITH JOHNNY SMITH JANE SMITH child spouse Hospital 010ct2006 010ct2006 010ct2006 Travel 010ct2006 010ct2006 010ct2006 Extended Health Benefits 010ct2006 010ct2006 010ct2006 Drugs 010ct2006 010ct2006 010ct2006 Dental 010ct2006 010ct2006 010ct2006 Basic Life 010ct2006 Accidental Death amp Dismemberment 010ct2006 Critical Conditions 010ct2006 010ct2006 010ct2006 short Term Disability 010ct2006 Long Term Disability 010ct2006 Query Done LL Local intr Page 108 of 128 Coverages Summary continued Benefit Descriptions Once the user has selected the grey Benefit Descriptions button the following screen will be presented In the section for Life and Disability there is a field entitled Eligible Amount and Approved Amount If the Approve
22. if the employee has three beneficiaries listed and wants the benefit to be equally paid the user would enter 33 33 and 34 Irrevocable Beneficiaries This option would only be selected in the case where the beneficiary may not be terminated by the insured without the beneficiary s consent Please refer to the contract for further information Click Continue to proceed to the next screen Page 14 of 128 Member Add Co ordination of Benefits COB This screen is populated if Co ordination of Benefits is selected on the Package Choices screen All fields must be completed If all information is not available the user can enter the wording unknown Completing as much information as possible in this screen is to the benefit of the group and the subscriber E ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross File Edit View Favorites Tools Help Ke TES Je dh BLUE CROSS WELCOMESIIARIVACY E MAIL T HELP 10GOUr ae r CACA General Member Selection Coverages Services Personal Data Package Choices Benefit Selection COB Policy ID 12345 Division 000 COMPANY ABC Owner ABCC System ID 500293428 Main Division Atlantic Regional Group Member Add Co ordination of Benefits Coverage Eff Date E Mar y 2002 Other Insurer Name of Insurer carrier Name Policy Number Identification 123 990 123123 Cardholder of Other Coverage Date of Birth Jane Smith 1 y Ja
23. inquiries to various areas within Blue Cross These options may not be available to all users 4 550 Application Menu Microsoft Internet Explorer provided by Medavie Blue Cross G pack gt i x 2 A Search Se Favorites GP media 4 AE aa Address 2 https fwv atl bluecross calssolUnifiiConsoleluvadesignlu_ uhm STATE _MNAME logonControllereuFn standardesn 0 Welcome to the Application Menu You have access to the following applications Chek On ES Enrolment Coy Group Coverage Information SUP supplies Request Form ING Other Group Administrator Inquiries 4 Ey Done 8 la Internet a Page 4 of 128 Welcome Page Once the user has selected ES from the Application Menu the following screen will be presented Policies The policies tab will display the policies and divisions to which the user has access Members The Members tab will allow the user to access the Search and Add New Member functions This tab would be selected each time the user wishes to view and or update eligibility information 23 ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross File Edit View Favorites Tools Help dh BLUE CROSS FRANCAIS Welcome TRAINING USER1 to Group Administrator Services Group Administrator Services gives you the opportunity to View policy lists to locate your specific policy Perform member specific transactions such as ad
24. is either regular college university or disabled The dependent status is determined by the rules of the contract If for example a dependent is covered under the parent s plan until age 21 then they are considered a REGULAR dependent until that time If they are between the ages of 21 and 25 the group allows the dependent to be covered under the condition that they are a full time student at college university the status would be COLLEGE UNIVERSITY If the status and age do not correspond to the terms of the contract the administrator will be presented with an error Disabled status must be approved by the medical underwriting team Please do not select this option send the appropriate paperwork to Blue Cross for assessment If the status is approved the medical underwriter will change the status to disabled Page 19 of 128 Member Add Insured Details continued If the dependent is within 60 days of becoming eligible as a student the user will be presented with a Pre Register Student option By checking this option the depdendent will be changed to student status when they become eligible without the user needing to make the changes a second time Click Continue to proceed to the next screen J Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross File Edit view Favorites Tools Help an ag Ea e ranea O dh BLUE CROSS WELCOME PRIVACY E MAIL HELP LOGOUT rosie BENE parse a
25. keyed the changes will be displayed as well as the date they were submitted E ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross Q sack X gt r x al FN JO search T Favorites Ol BR wi Leal rel 3S dh BLUE CROSS WELCOMEsjsPRIVACY E MAIL HELP 10GOur i a Policies members Parties Search General Member Selection Coverages Request ID Activity Details Updates Policy ID 12345 Division 001 7 COMPANY ABC Owner ABCC Sub Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 600293426 Member Updates Userld Date Description WebGA O05Dec2006 Policy division province WebGA O05Dec2006 Insured Details WebGA 05Dec2006 Life Disability Benefits Query Delete Eje LY e intranet Page 115 of 128 Services Updates continued Deleting Changes Any changes that have been submitted will be displayed in a summary form in the Services Updates tab The User ID of the person who keyed the changes will be displayed as well as the date they were submitted The user can delete these changes by selecting the Delete option from the blue navigation bar on the bottom of the screen If there are stacked changes on the Activity Details screen the portion of the changes not yet processed will still appear on the Updates tab In this case the user is not able to delete the changes Note lf the changes were keyed by a different user the current user is able to delete
26. l a LEE E toca intranet Page 79 of 128 Member Selection Benefits continued Revising Benefits continued To revise the package select the package options from the boxes entitled Health Coverage Options and Life Coverage Options where applicable Enter the effective date and then click the grey Replace button Click Continue to proceed into the workflow A ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross File Edit View Favorites Tools Help Jh BLUE CROSS WELCOME PRIVACY E MAIL HELP LOGOUT a al Potcies Members orcics ee Search General Packages Policy ID 12345 Division 0009 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293428 Member Package Revision Package Choices Health Coverage Options Life Coverage Options M Medical IV Life Dental M Disability Health Care Province NB Effective Date fi y Oct y 2004 Replace Continue Cancel Delete LT eg Local intr Page 80 of 128 Member Selection Benefits continued Revising Benefits continued Once the user has clicked the grey Replace button the employee s current benefit packages are listed and then all available packages for the date selected are listed Select the appropriate package as well as the rating status If one of the options is to be waived click the box to the left of Waive Reason and then select the
27. participants who will be removed terminated from the plan Click Update to proceed es ABCC Enrollment Microsoft Internet Explorer provided by Medayvie Blue Cross File Edit view Favorites Tools Help O X a a gme di BLUE cross See ee m Policies Members Portics ee insureds Benefits co ordination of Benefits of Benefits Beneficiaries usa Policy ID 12345 Division 000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293426 Insured List M Insured Status eth Ot Eff Trans Date Term Dt Term Trans Dt Family 010ct2006 17Nov2006 Tag Name Gender Date of Birth Age Eff Dt Term Dt C 00 JOHN SMITH Male O1Jan1970 0 010ct2006 Member Iv 01 JANE SMITH Female 01Jan1970 36 010ct2006 Spouse id 02 JOHNNY SMITH Male 01Jun2005 1 010ct2006 Child Regular Addinsured Update Query CL E Local intra Page 49 of 128 Member Selection Insureds continued Changing to Single Status continued Once the user has selected Update from the previous screen the following will be presented Select the new status from the dropdown menu and enter the effective date of the change Enter a termination date one day prior to the effective date of the change beside each participant who will no longer be covered under the plan Click Save to process the changes Note the user cannot go back more than 31 days in the past Requests that are beyo
28. the user clicks Continue from the previous screen the following confirmation screen will be presented The user must click Submit in order to save the changes If at any time during the workflow the user wants to cancel the transfer they can click Delete from the bottom navigation bar J ABCC Enrollment Microsoft Internet Explorer provided by Medayie Blue Cross Fie Edit View Favorites Tools Help dh BLUE CROSS WELCOMEspePRIVACY E MAIL T HELP 1 10G0UT am Poticies Members Partics Search Member Selection Coverages Services Reinstate Transfers Insured Details Confirm Policy ID 12345 Division 0009 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293426 JOHN SMITH 500293426 Member Reinstate Transfers Confirm The collection of the enrollment data for this member has been done Please select submit to approve the details Submit Delete 0 LT Rf Local intr Page 47 of 128 Member Selection Insureds dh BLUE CROSS WELCOME PRIVACY E MAIL HELP woGour Pa m mo um _ a Poticies Members Partics Search General Coverages Services insureds Benefits co ordination of Benefits of Benefits Beneficiaries usa Within the Member Selection Insureds tab the user will be able to Change the rating status of a plan ex Single Couple Family Add Terminate Spouse and or Dependent Information Update Spouse and or Dependent Informati
29. the user is unsure of the process then the change should be forwarded to Blue Cross for processing Click Save to process the changes 3 ABCC Enrollment Microsoft Internet Explorer provided by Medayie Blue Cross File Edit View Favorites Tools Help O ih BLUE CROSS E MALL A al Poticies Members rarcics Search General Coverages Services Insureds Co ordination of Benefits Policy ID 12345 Division 0009 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293426 Insured List Insured Status Family Status Eff Dt fi Oct 2006 Tag 00 Relationship Gender Date of Birth Term Dt First Name JOHN Member Male O1Jani970 Last Name SMITH Relationship Gender Date of Birth FirstName S e A EO Day Month Last Name Dependent Status I Late Applicant Save Cancel or Oaa L EE E Local intr Page 53 of 128 Member Selection Insureds continued Changing to Family Status and Reinstating Participants The following outlines the steps to change the rating status from a lesser rating status to a greater rating status ex single status to couple or family status or couple status to family status Once the user has accessed the employee s information they are to select the Member Selection Insureds tab The following screen will be presented When there are grey buttons on the screen that state Show History please click the grey butt
30. these changes also Please be sure to double check that the User ID does not belong to someone else before deleting the changes 2 ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross File Edit View Favorites Tools Help ae Back x x E A 4 Search 5 Favorites 4 i wi rel 3 Address dh BLUE CROSS WELCOME PRIVACY E MAIL HELP LOGOUT Policies Members Parties Request ID Activity Details Updates Policy ID 12345 Division 001 7 COMPANY ABC Owner ABCC Sub Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293426 Services Member Updates Userld Date Description WebGA O05Dec2006 Policy division province WebGA O05Dec2006 Insured Details WebGA 05Dec2006 Life Disability Benefits Query Delete Dom LY E Local intranet Page 116 of 128 APPENDIX A Quick Reference Guide for Member Enrolment and Updates BLUE CROSS Group Administrator Website Quick Reference Guide Member Enrolment and Updates Page 117 of 128 Purpose The purpose of this document is to provide a brief overview of the Group Administrator Website for greater detail please refer to the online User Guide Application Menu Once the user has logged into the Group Administrator s website the Application Menu will be presented To access eligibility files the user is to select ES Enrolment which will enable them to add change or inquire on benef
31. 00293428 JOHN SMITH 500293428 Member Add Package Confirm The collection of the enrollment data for this member has been done Please select submit to approve the details Submit Delete oT Loca intrare Page 78 of 128 Member Selection Benefits continued Revising Benefits The Revise Package option allows the user to either replace or backdate the existing benefit packages that the employee has Selecting the Revise Package option will take the user into a workflow e ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross i dh BLUE CROSS WELCOME sjsPRIVACY E MAIL HELP i Policies Members Parties Search General Coverages Services Benefits HSA Policy ID 00891 Division 000 2 SKILLSOFT Owner ABCC Main Division Atlantic Regional Group Ext ID osoz 11176 SHAWN M QUINLAN 050211176 Benefit Selections Medical C AA MEDICAL PACKAGE 1 Eff Dt EffTrans Dt Term Dt Term Trans Dt Rating Status Family 4 Hospital 01Sep2003 28Aug2003 F Travel 01Sep2005 26Aug2005 45 Extended Health Benefits 01Sep2005 26Aug2005 10 Drugs 01Sep2003 26Aug2005 Dental C AA DENTAL PACKAGE 1 Eff Dt EffTrans Dt Term Dt Term Trans Dt Rating Status Family 6G Dental O1Sep2005 26Aug2005 Life e Coverage A ALLEMPLOYEES CRITICAL CONDITION Applied For Eff Dt Eff Trans Dt Term Dt Term Trans Dt Add Coverage Amount Update Coverage Amount Add Package Revise Package Terminate Package Query Ee
32. 0293428 JOHN SMITH 600293426 Member Add Package Package Choices Health Coverage Options Life Cove rag o Please verify and apply medical underwriting updates if required I Medical M Life we ae a 4re you sure you wish to submit this as is I Dental I Disability Cancel Effective Date fi y Dec y 2006 Current Employee Classes Packages Medical AA MEDICAL PACKAGE 1 Family Eff Date 01Sep2003 4 Hospital F Travel 45 Extended Health Benefits 10 Drugs Dental AA DENTAL PACKAGE 1 Family Eff Date O1Sep2003 6G Dental Life A ALL EMPLOYEES LIFE 1 Eff Date 01Jun2000 3 Basic Life Continue Cancel Delete El Done zz ff fff RD Local intra Page 74 of 128 Member Selection Benefits continued Add Benefits continued The second tab of the workflow will present beneficiaries if life coverage is a benefit on the employee s plan The current information will be presented the user can update this information if required Click Continue to proceed BY ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross Fie Edit Yiew Favorites Tools Help Ke Jac dh BLUE CROSS WELCOME PRIVACY E MAIL HELP LOGOUT ee lt Poticies Members aries rs Search General Coverages Services Beneficiaries Policy ID 12345 Division J000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293428 Member Add Package Beneficiar
33. 2345 Division J000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293428 Insured List C Insured Status Eff Dt Eff Trans Date Term Dt Term Trans Dt Family 010ct2006 17 Nov2006 Tag Name Gender Date of Birth Age Eff Dt Term Dt O 00 JOHN SMITH Male O1Jan1970 36 01 0ct2006 Member O 01 JANE SMITH Female 01Jan1970 36 010ct2006 Spouse C 02 JOHNNY SMITH Male O1Jun2005 1 010ct2006 Child Regular Add Insured Update Query Done ae i a a Local intrat Page 57 of 128 Member Selection Insureds continued Adding a Participant to a Family plan Spouse or Dependent continued Once the user has selected Add Insured from the previous screen the following screen will be presented Please add the details of the new participant in the fields provided If additional participants are to be added click the grey More Insureds button Click Save to submit the changes ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross Fie Edit view Favorites Tools Help WELCOME PRIVACY E MAIL HELP LOGOUT dh BLUE CROSS Policies Members Parties Search General insureds Benefits co ordination of Benefits of Benefits Beneficiaries usa Policy ID 12345 Division 0009 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293426 JOHN SMITH 600293426 Insured List Insured Sta
34. 6 Member Reinstate Insured Details First Name Relationship Date of Birth JOHN Member 01Jan1970 Last Name Gender Privacy Consent SMITH Male Yes Continue Cancel Delete ELit Page 31 of 128 General Miscellaneous continued Reinstatement of Benefits continued If the user has clicked the grey More Insureds button from the previous screen additional fields are presented in which the user can add additional dependents The dependent information that was on file at the time of termination will be pre populated on this screen Only additional information can be added from here If the user needs to change or delete the information on file this will be done in a second step once the reinstatement has been saved See the section on Member Selection Insureds Modifying Insured Details for details on this additional step Click Continue to save the changes lt ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross Fie Edit wiew Favorites Tools Help o ja dh BLUE CROSS Se es E O i Poticies Mms Parties services General Reinstate Transfers Transfers Packages insured Details Policy ID 12345 Division O00 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 600293426 Member Reinstate Insured Details First Name Relationship Date of Birth JOHN Member O1Jan1970 Last Name Gender Privacy Consent SMITH Male Ye
35. BLUE CROSS Group Administrator Website User Guide Version 2 0 Table of Contents HAT OCU COM sausage cos reser ea tase cio eee eS 3 Quick Reference Guide for Member Enrolment and Updates cccccceeeeeeeeeeees 3 Quick Reference Guide for Member Inquiry 00ssssssssssssssessssssssesssseeeeeeeeeeees 3 Signing into the Group Administrator Website ccc ccccccccsseeeseeeeeeeeeeaaeeeeeeeeeeeeeeaaaaeees 4 NV CICOIMNG PaE rsim E atten welelonumeisdaste 5 Enrolling Members for Benefits cj sciscsvecccscsec icieesheedcenang tdhapieteticnes nadamacensedeanedeibadcendiolasieacsmnntetlan 6 Member Information and Changes ccccccccsssseecceeeceeeeeeeeeeeeeeeaeeseeeeeeeeessaaeseeeeeeeessaaaaeess 22 Memper SOCAN CIN srs a a a e a E a 22 Warning Error Me SSageO ccccccseseeccceseeeeceeeeeeceeseeecaaeeessaueeeeseseeessageeessaeseeeneegeeeas 23 Change Member Information ccccccccccccceceeeseeeeeeeseeeeeeeeeeeeeeesueeeseeeeeeesssuaaaeeeeeens 26 Termination Of COVGraG 6 s ii 52 220200ccce5sscevedeesecenncacceentesseonccossteteredecndondsesedecedshcevedestesecoossueee 27 Reinstatement of Benefits cc cecccccscecceceeseeeceeeeeeeaeeeeseaseeeeseaeeeeseaeeeessaeseeesageeeeseas 28 Employment D tails srecen aa aN 35 GrOSS ReIGrENCES honsnpineakn a aN 37 Salary INFORMAUON erian a E EOE 38 IWAN STU S acea aa a Oa E e a a a 42 Cha
36. D 12345 Division 000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293426 Member Reinstate Effective Date 1 y Dec y z006 Policy 12345 Division ooo Continue Cancel Delete He el al Local intran Page 28 of 128 General Miscellaneous continued Reinstatement of Benefits continued Once the grey Query button has been selected from the previous screen the user will be presented with additional information The province in which claims are to be adjudicated can be changed if necessary from here Click Continue on the navigation bar at the bottom of the screen to proceed to the next phase of the workflow ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross Fie Edit View Favorites Tools Help T dh BLUE CROSS WELCOME PRIVACY E MAIL HELP LOGOUT o ll Poticies Members partic Search Member Selection Coverages Services Reinstate Transfers Policy ID 12345 Division 000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 600293426 Member Reinstate Effective Date E Dec y 2006 Policy 12345 Division ooo Query Company Name COMPANY ABC Reason for Division Main Division External ID 500293426 Health Care Province NB gt Continue Cancel Delete Done 4 is BE i f al Local intra Page 29 of 128
37. Dental benefits thus the Co ordination of Benefit information is not required A ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross gt File Edit View Favorites Tools Help Ke a iai _ dh BLUE CROSS WELCOME PRIVACY E MAIL HELP LOGOUT lil Policies Members Partics Member Selection Insureds Co ordination of Benefits HSA Policy ID 12345 Division 0009 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293426 JOHN SMITH 500293428 Co ordination of Benefits Coverage Effective Date E Feb 2002 gt Coverage Termination Date Day Month VYear Other Insurer Name of Insurer carrier Name Policy Number 123 999 Identification 123987 Cardholder of Other jane Smith SCS oe Coverage Jane Smith Date of Birth fi Jan 1970 Type of Coverage All Vision Hospital Drugs Extended Health Benefits Dental gt Insureds All Spouse C List Specific Insureds aaan SOSO Save Cancel LLL E boca intra Page 97 of 128 Member Selection Beneficiaries Policies mesa Parties Search Co ordination of Benefits Insureds Beneficiaries Within the Member Selection Beneficiaries tab the user will be able to Add Update the beneficiary information Note Users with inquiry only access will only be able to view the above information 3 ABCC Enrollment Microsof
38. Division 000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 600293426 Benefit Selections Medical MEDICAL PACKAGE 1 Eff Dt Eff Trans Dt Term Dt Term Trans Dt Rating Status Family 4 Hospital 015ep2003 26Aug2003 F Travel 015ep2003 26Aug2003 45 Extended Health Benefits 015ep2003 26Aug2003 10 Drugs 01Sep2003 26Aug2003 Dental C DENTAL PACKAGE 1 Eff Dt Ef Trans Dt Term Dt Term Trans Dt Rating Status Family 6G Dental 01Sep2003 26Aug2003 Life C Coverage ALL EMPLOYEES CRITICAL CONDITION Applied For Eff Dt Eff Trans Dt Term Dt Term Trans Dt Rating Status Family C3 Critical Conditions 50 000 00 01May2005 23Apr2005 ALL EMPLOYEES OPTIONAL SPOUSE Coverage LIFE Applied For Eff Dt Eff Trans Dt Term Dt Term Trans Dt 1 Optional Spouse Life 40 000 00 O1Sep2001 17Aug2001 C ALL EMPLOYEES LIFE 1 Eff Dt Eff Trans Dt Term Dt Term Trans Dt 3 Basic Life O1Jun2000 29May2000 Disability C ALL EMPLOYEES DISABILITY 1 Eff Dt Eff Trans Dt Term Dt Term Trans Dt 3 Short Term Disability 16Mar2000 30Mar2000 Add Coverage Amount Update Coverage Amount Add Package Revise Package Terminate Package Query Done od i mi a Local intr Page 69 of 128 Member Selection Benefits continued Update Coverage Amount Optional Life Benefits Only continued Once the user has selected Update Coverage Amount from the previous screen the following is presented The user can enter a new a
39. LOGOUT Ext ID 500293428 JOHN SMITH 500293428 Benefit Selections Medical ce MEDICAL PACKAGE 1 Eff Dt EffTrans Dt Term Dt Term Trans Dt Rating Status Family 4 Hospital 010ct2006 17Noyv2006 F Travel 010ct2006 17Nov2006 1 Extended Health Benefits 010ct2006 17Noyv2006 5 Drugs 010ct2006 17 Nov2006 Dental DENTAL PACKAGE 1 Eff Dt Eff Trans Dt Term Dt Term Trans Dt Rating Status Family 9 Dental 010ct2006 17Nov2006 Life ALL EMPLOYEES LIFE Eff Dt Eff Trans Dt Term Dt Term Trans Dt 3 Basic Life 010ct2006 17Nov2006 1 Accidental Death amp Dismemberment 010ct2006 17Noyv2006 Add Coverage Amount Update Coverage Amount Add Package Revise Package Terminate Package Query Done m x leq al Local intral Page 90 of 128 Member Selection Benefits continued Terminating Benefits continued Once Terminate Package has been selected from the previous screen the user will be able to enter the termination date by selecting the information from the dropdown boxes Click Save to process the changes F ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross Fie Edit Yiew Favorites Tools Help O a a dh BLUE CROSS WELCOME PRIVACY MAIL HELP tocour Policies Members Products Parties Search General Coverages Services Policy ID 12345 Division 0009 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 5002934268 JOHN SMITH 500293426 Benefit Selec
40. PANY ABC Owner ABCC System ID 500293428 Main Division Atlantic Regional Group Member Add Member Personal Data Enrollment C Initial Subsequent External ID 500293428 Last Name Smith First Name jonn Address 123 Main Street anywhere Towa N8 s Ss sSsSOSOCCS Postal Code Telephone Number so6 555 5555 Health Care Province NB z Language English gt Permanent Date Employed Mo x oct zlfeood Continue Cancel Delete Pre LL Aian Page 8 of 128 Member Add Personal Data Once the Name Policy ID and Division have been entered on the Member Search Screen select the Add Member option from the blue navigation bar on the bottom of the screen The name policy and division will be carried forward to the Member Personal Data screen The section entitled Enrollment will normally be defaulted to Subsequent and the user will not be able to change the selection If the group and division are new and are in the process of being created the field will be flagged to initial until the first bill is created The user should leave the Initial radio button selected Complete the Address and Telephone Number fields Select the Health Care Province in which claims will be adjudicated from the dropdown menu Complete the Language and Permanent Date Employed fields The effective date of coverage will be calculated as per the conditions of the contract based on the date entered in this field Note lf the numbe
41. Revise Terminate Benefits Benefit Summary Summarizes all changes to benefit coverage Search General Member Selection Services summary Coverages Summary Coverage is listed by participant The date field can be used to query past and future benefits Benefit Description button displays card wording as well as life coverage Search General Member Selection Coverages Request I Services Request ID Activity Details Updates Request ID Cards Status history View Delete Current Day Transactions Dates Card Were Created Policy Number History Pending Changes Page 123 of 128 APPENDIX B Quick Reference Guide for Member Inquiry BLUE CROSS Group Administrator Website Quick Reference Guide Member Inquiry Page 124 of 128 Purpose The purpose of this document is to provide a brief overview of the Group Administrator Website for greater detail please refer to the online User Guide Application Menu Once the user has logged into the Group Administrator s website the Application Menu will be presented To access eligibility files the user is to select ES Enrolment which will enable them to inquire on benefits for members a E anr _ Tm j e z dh BLUE CROSS m _ Sp er e O MENU gss o ENF _ Welcome to the Application Menu You have access to the following applications Chick On ES Enrolment ES Guide Enrollment User uide Coy Group Coverage Information SUP supplies Request Form
42. Spouse 100 No MEDPA1 17Nov2006 Update Query CL Local intra Page 99 of 128 Member Selection Beneficiaries continued Beneficiaries continued Once Update has been selected the user can make changes to the Beneficiary information Multiple Beneficiaries lf there are multiple beneficiaries the percentages must add up to 100 The percentages must be assigned as whole values For example if the employee has three beneficiaries listed and wants the benefit to be equally paid the user would enter 33 33 and 34 Irrevocable Beneficiaries This option would only be selected in the case where the beneficiary may not be terminated by the insured without the beneficiary s consent Please refer to the contract for further information Click Save to submit the changes zs ABCC Enrollment Microsoft Internet Explorer provided by Medayie Blue Cross Fie Edit Yiew Favorites Tools Help Q ez ja _ dh BLUE CROSS WELCOME PRIVACY E MAIL HELP LOGOUT E Poticies Members ovics Co ordination of Benefits Beneficiaries Policy ID 12345 Division 0009 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 600293426 JOHN SMITH 500293426 Update Beneficiary Last Name First Name Relationship Percentage Irrevocable Update Id Smith Jane Spouse gt a MEDPAI a SO se tC o A A E roo a Save Cancel Ebon LL E koanta Page
43. Terminate from the navigation bar on the bottom of the screen The following screen will be presented Enter the effective date of the termination and the reason for the termination Click Save on the navigation bar at the bottom of the screen If the change is being entered for the 1 of the month the premiums will be billed for the full month If the 1 of the month is entered a warning message will be presented to remind the user of the implications of this change Note The employee is covered until midnight of the termination date entered so if they are to be covered for the full month of November the user can key Nov 30 as the termination date Bs ABCC Enrollment Microsoft Internet Explorer provided by Medayie Blue Cross File Edit wiew Favorites Tools Help O og la dh BLUE CROSS WELCOME PRIVACY E MAIL HELP LOGOUT m pt Poticies Members ffonia General Miscellaneous Policy ID 12345 Division D009 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293426 JOHN SMITH 500293428 Update Miscellaneous Name JOHN SMITH Address 123 MAIN STREET ANYWHERE TOWN NB Postal Code Telephone Number 506 555 5555 Effective Date 010ct2006 Termination Date Day Month Year gt Paid to Date Termination Reason Policy Series Retention Group Language English Save Cancel javascript top uSubmit MemberGeneralMiscIng memberGeneralMiscInquiry BB is al Local i
44. Tools Help dh BLUE CROSS Policies Members Parties Search General Co ordination of Benefits Policy ID 12345 Division 000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293428 Co ordination of Benefits Last updated on 17Nov2006 Last Updated By MEDPA1 Effective Date of Coverage 01Feb2002 Termination Date of Coverage Other Insurer Carrier Name Policy Number 123 999 Identification Number 123987 Cardholder Name Jane Smith Cardholder Birthdate 01Jan1970 Type of Coverage ALL 3 HOSPITAL VISION DRUGS EXTENDED DENTAL Insureds All Update Query Done o BE Cy Local intrar Page 96 of 128 Member Selection Co ordination of Benefits continued Co ordination of Benefits continued Once the user has selected the Update button from the previous screen the fields become editable and the user can enter the appropriate changes If the co ordination of benefits is no longer in effect then the user would enter a termination date in the Coverage Termination Date field All fields must be completed If not all information is available the user can enter the wording unknown Completing as much information as possible in this screen is to the benefit of the group and the subscriber Co ordination of Benefit information is applicable only to Health and Dental benefits If the member has Life benefits only ie they do not have Health and or
45. a dh BLUE CROSS WELCOME PRIVACY E MAIL HELP woGouT A Policies Members Products Parties m Search General Coverages Services Benefits usa Policy ID 12345 Division 000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293428 Benefit Selections Employee Class A Package ALL EMPLOYEES OPTIONAL SPOUSE LIFE Coverage Applied For Eff Dt 1 Optional Spouse Life g s0000 i Dec 2006 gt Save Cancel EP l LEE Bian Page 68 of 128 Member Selection Benefits continued Update Coverage Amount Optional Life Benefits Only This option applies only to Optional Life Optional Spouse Optional Child Critical Conditions and Optional AD amp D benefits To change the amount with the same effective date or to backdate the information the user would select the radio button to the left of the life option to be updated and then click the Update Coverage Amount option from the blue navigation bar on the bottom of the screen Note To change the amount or to enter a new effective date greater than the date on file please see the section on Add Coverage Amount Optional Life Benefits Only cS ABCC Enrollment Microsoft Internet Explorer provided by Medayvie Blue Cross File Edit View Favorites Tools Help dh BLUE CROSS WELCOME PRIVACY E MAIL HELP woGouT Me a Poticies Members Parxics Benefits HSA Policy ID 12345
46. al Membership Details ih BLUE CROSS Search Member Selection Coverages Services Member Activity Membership Details Within the General Membership Details tab the user will be able to View Update Employment Details View Update Cross Reference IDs View Update Salary Information Note Users with inquiry only access will only be able to view the above information 3 Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross Ele Edit View Favorites Tools Help dh BLUE CROSS Se er oor lt Policies Members Parties TY Search Member Selection Coverages Services Member Activity Policy ID 12345 Division 000 9 COMPANY ABC Owner ABCC Membership Details Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293428 Membership Details Employment Details Occupation Category Senior executive management and professionals Occupation ACCOUNTANT Permanent Employment Date 010ct2006 Cross References Alternate ID 1 Alternate ID 2 Previous Membership Salary Information Hours Calculated salary Frequency perVVeek Eff Dt Eff Trans Dt Term Dt Term Trans Dt Annual Salary 65 000 00 Yearly 010ct2006 17Nov2006 65 000 00 Add Update Query SL E oana Page 34 of 128 General Membership Details continued Employment Details To add or modify occupation information select General from the navigation bar on
47. alth Spending Account Contribution Year 2007 Yearly Deposit 1500 Effective Date fi y Jan 2007 Save Cancel oT B IE Local intr Page 103 of 128 Member Selection HSA continued Update Health Spending Account HSA To update existing HSA information click the radio button to the left of the appropriate year and then click Update from the blue navigation bar on the bottom of the screen E ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross File Edit view Favorites Tools Help 1O g t p dh BLUE CROSS WELCOME PRIVACY E MAIL HEL LOGOUT PA Poticies Members Parcics Search General Coverages Services Co ordination of Benefits Policy ID 12345 Division 000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293426 Health Spending Account Contribution Year Current Balance Effective Date Term Date Forfeit Date 2005 12 01 Mar2005 31Dec2005 26Feb2006 2006 12 01Jan2006 31Dec2006 26Feb2007 Add Update Query Delete Done mz a z E k Local intr Page 104 of 128 Member Selection HSA continued Update Health Spending Account HSA continued Once Update has been selected from the previous screen the user is able to change the information for the HSA for the contribution year selected Please ensure when the dates and amounts are altered that the terms of the contract are being
48. ansactions Policy Number History Page 128 of 128
49. ast and future benefits Note Users with inquiry only access will only be able to view the above information J ABCC Enrollment Microsoft Internet Explorer provided by Medayie Blue Cross File Edit view Favorites Tools Help Q Ta gk BLUE CROSS cohen MAIL HELP moo ww _ Porcies Members aries Search General Member Selection Services summary Summary Policy ID 12345 Division 000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 600293426 Date 1 Dec 2006 Policy ID 12345 Division 000 Coverage Summary represents benefit limitations JOHN SMITH JOHNNY SMITH JANE SMITH child spouse Hospital 010ct2006 010ct2006 010ct2006 Travel 010ct2006 010ct2006 010ct2006 Extended Health Benefits 010ct2006 010ct2006 010ct2006 Drugs 010ct2006 010ct2006 010ct2006 Dental 010ct2006 010ct2006 010ct2006 Basic Life 010ct2006 Accidental Death amp Dismemberment 010ct2006 Critical Conditions 010ct2006 010ct2006 010ct2006 Short Term Disability 010ct2006 Long Term Disability 010ct2006 Query oT RE Local intr Page 107 of 128 Coverages Summary continued Coverage Summary To view a summary of benefits available to the employee select the Coverages Summary tab The date is defaulted to the current day but a search can be done to view past and future dates by selecting the date required and then selecting Query from the
50. ation bar The Add function would also be used if the user is entering an effective date greater than the effective date of the current salary For example if the user is entering revised salary information and the effective date is greater than the date on system then the Add function would be selected as opposed to the update function Note lf an hourly rate is entered the number of hours must also be entered in the Hours per Week field 3 ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross Fie Edit Yiew Favorites Tools Help dh BLUE CROSS WELCOME PRIVACY E MAIL HELP LOGOUT puus Policies Members Pomes General Membership Details Policy ID 06975 Division 1022 COMPANY XYZ Owner ABCC Sub Division Atlantic Regional Group Ext ID 500293378 JOHN SMITH 500293376 Update Membership Details Salary Information Hours salary Frequency per Week Eff Dt Hourly Day Month y Vear gt Save Cancel e E D f M Local intrar Page 39 of 128 General Membership Details continued Update Salary Information If salary information is already on the screen and the user is changing the information but the effective date of the change is less than or equal to the effective date of the current salary information then the information needs to be updated and not added The Update option would have been selected from the navigation bar on the bottom of the previous screen f
51. ave Please note that the user must also have access to the group and section in which the other ID resides in order to use this function A ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross Fie Edit Yiew Favorites Tools Help e aad a dh BLUE CROSS WELCOMEspsPRIVACY E MAIL J HELP 1 10GOUT ill f Poticies Members Partics General Membership Details Member Activity Policy ID 12345 Division 0009 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293426 JOHN SMITH 500293426 Update Membership Details Cross References Alternate ID 1 Alternate ID 2 Previous Membership Other ID Package I Detach Save Cancel Done CITIT amp Local intrar Page 37 of 128 General Membership Details continued Salary Information To add or modify salary information select General from the navigation bar on the top of the screen and then the Membership Details tab Click the radio button to the left of the Salary information field If there is no salary information on the screen select the Add option from the navigation bar on the bottom of the screen If salary information is present the Add function or the Update function could be selected the choice is dependent on the effective date of the change If the effective date of the change is less than or equal to the effective date of the current salary information the user would select the Update o
52. cal intrar Page 63 of 128 Member Selection Insureds continued Student Pre Registration continued Once Update has been selected the user will be presented with the dependent s information and the option to Pre Register them as a student Simply check the Pre Register Student box and then click Save in the navigation bar on the bottom of the screen BY Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross Fie Edit Yiew Favorites Tools Help dh BLUE CROSS i MAIL HELP 1oGour Poticies Members parties Ne M Search General Coverages Services insureds Benefits co ordination of Benefits Beneficiaries nsa Policy ID 12345 Division 0009 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293426 JOHN SMITH 500293426 Insured List Insured Status Family Status Eff Dt 010ct2006 Tag 03 Relationship Gender Date of Birth Term Dt First Name JAIME Child gt Female E Aug v 1986 Day Month y Vear gt Last Name SMITH Dependent Status Regular M Pre Register Student Save Cancel Delete CTD ed toca intra Page 64 of 128 Member Selection Insureds continued Student Pre Registration continued Once the user selects Save from the previous screen they will be returned to the Member Selection Insureds screen The screen will be updated indicating that a Student Pre Registration change is pendin
53. d Amount is zero the employee does not have this benefit It would typically be in the process of being underwritten when displayed in this manner A ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross Fie Edit View Favorites Tools Help O Sg le ge BLUE CROSS WELCOME joPRIVACY E MAIL HELP 10GOUT Mn Policies members Parties Search General Member Selection i Summary Policy ID 12345 Division 0009 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293426 JOHN SMITH 500293426 Benefit Descriptions As of 11Dec2006 Policy ID 12345 Division 000 Medical Dental Coverages Hospital semi private room 100 direct pay In Canada only Worldwide Travel includes referrals out of Canada 100 reimb None Available Drug Benefits direct pay the participant pays 20 for each eligible prescription item 9 None Available na Tn amp Life Disability Coverages Employee Class A ALL EMPLOYEES LIFE 3 Basic Life Eligible Amount 25 000 Approved Amount 25 000 Waiver of premiums yes 1 Accidental Death amp Dismemberment Eligible Amount 25 000 Approved Amount 25 000 Waiver of premiums yes Employee Class A ALL EMPLOYEES CRITICAL CONDITIONS C3 Critical Conditions Eligible Amount 50 000 Approved Amount 50 000 Waiver of premiums no Employee Class A ALL EMPLOYEES DISABILITY 3 Short Term Disability Eligible Amount 750 Approved Amount 750
54. ding a new member or dependent or changing address or benefits Perform member searches to locate a specific member of a policy and or view member information Click On You have entered a secure area If your connection is inactive for more than 30 minutes your connection will be terminated work in progress on your desktop will not be submitted and you will be required to repeat your login to this site For security reasons you cannot bookmark any page beyond this point amp e EEE B loan Once the Members tab has been selected a secondary navigation bar is presented To begin any work the user must start with the Search tab Policies Members raves MA General Member Selection Coverages Services Page 5 of 128 Enrolling Members for Benefits Member Search Once the administrator has selected ES from the Application Menu they must click on the Members tab and then select the Search tab from the secondary navigation bar From here the Search screen will be presented Member Add For the purpose of adding benefits for a member select the radio button beside Name Complete the fields for Policy ID Division Last and First Name Select the Add Member option from the blue navigation bar on the bottom of the screen E ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross File Edit wiew Favorites Tools Help H BLUE CROSSO WELCOME PRIVACY E MAIL HELP LOGOUT Po
55. e LLL B E boca inter Page 81 of 128 Member Selection Benefits continued Revising Benefits continued Once the packages have been chosen the user is taken to the Insured Details tab where current information is displayed Additional insureds can be added at this point by selecting the grey More Insureds button If changes are required to current information on file please refer to the section entitled Member Selections Insureds Modifying Insured Details Click Continue to proceed Bs ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross Fie Edit Yiew Favorites Tools Help dh BLUE CROSS WELCOME PRIVACY E MAIL HELP LOGOUT m Policies Members Partics fser vices Insured Details Policy ID 12345 Division 0009 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293426 JOHN SMITH 500293428 Member Package Revision Insured Details First Name Relationship Date of Birth JOHN Member 01Jan2006 Last Name Gender Privacy Consent SMITH Male Yes First Name Relationship Date of Birth JANE Spouse O1Jan1970 Last Name Gender Privacy Consent SMITH Female Yes Marital Status Date First Name Relationship Date of Birth JOHNNY Child 01Jun2005 Last Name Dependent Status Gender Privacy Consent SMITH Regular Male Yes More Insureds Continue Cancel Delete Done rT f 7 Local intra Page 82 of 128 Member Selection Benefits continued R
56. e done refer to the online User Guide under Member Search di BLUE CRC WELCOME PRIVACY E MAIL HELP LOGOUT rt General Member Selection Member Search Active Active and Terminated Search by external identification number alternate identification number system identification number ai hame Policy ID Division Identification Number e Last Mame First Mame Clear Search Fields Query Page 127 of 128 Summary of Member Benefits and Information Search Member Selection Coverages Services Miscellaneous Membership Details Member Activity General Miscellaneous Membership Details Member Activity Name Employment Details Transfer History Address Salary Search General Coverages Services Insureds Benefits Co ordination of Benetits Member Selection Insureds Benefits Co ordination of Benefits Beneficiaries H S A Status Information Benefits Displayed With History COB Information Beneficiary Information Displays Details Spouse Information Dependent Information Search General Member Selection Services Summary Coverages Summary Coverage is listed by participant The date field can be used to query past and future benefits Benefit Description button displays card wording as well as life coverage Search General Member Selection Coverages Request I Services Request ID Activity Details Updates Dates Card Was Created Status History View Current Day Tr
57. e late the waiting period is applied and if they are not late the waiting period is waived Late Status is also determined based on the same criteria as the Claim Waiting Period Note These functions are currently not displaying properly but will not affect the application If the user encounters difficulties with this process please contact the webadmin support team Click Continue to proceed to the next screen Page 11 of 128 Member Add Benefit Selection Benefit Selection are displayed as the third tab on the enrolment workflow All available packages pertinent to the selected policy and division as well as the effective date of coverage will be presented on this screen 3 ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross Fie Edit View Favorites Tools Help ih BLUE CROSS WELCOMEsjePRIVACY E MAIL HELP 10Gour et a pa Y General Member Selection Coverages Services Personal Data Data Package Choices Choices Benefit Selection Policy ID 12345 Division D00 COMPANY ABC Owner ABCC System ID 500293428 Main Division Atlantic Regional Group Member Add Benefit Selection Select a Health Coverage Option If packages have rating status s marked with a they must have the same value Medical AA MEDICAL PACKAGE 1 Mandatory 4 Hospital Health Care Province NB Rating Status Family gt F Travel sa 1 Extended Health Benefits Waive m Waive Reason 5 Drugs
58. e rating status s marked with a they must have the same value C Medical AA MEDICAL PACKAGE 1 Mandatory 45 Extended Health Benefits Health Care Province NB Rating Status gt ba si Waive m Waive Reason gt 4 Hospital Dental AA DENTAL PACKAGE 1 Mandatory 6G Dental Health Care Province NB Rating Status Waive D Waive Reason gt select a Life Coverage Option Life A ALL EMPLOYEES LIFE 1 Mandatory Waive E Waive Reason Continue Cancel Delete CL TL E toca intre 3 Basic Life Page 30 of 128 General Miscellaneous continued Reinstatement of Benefits continued Insured Details is the third screen that will be presented The dependents if any who were on the plan at the time of termination will be listed and can be modified on this screen If the rating status is single then the user can click Continue to proceed If the rating status is to be couple or family then the user is to click the grey More Insureds button to reconfirm or add new information A ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross File Edit View Favorites Tools Help dh BLUE CROSS WELCOME PRIVACY E MAIL HELP LOGOUT Poticies Members Parties services General Reinstate Transfers Packages insured Details Policy ID 12345 Division 000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 50029342
59. een Page 17 of 128 Member Add Insured Details The names and dates of birth of the member their soouse and dependents if applicable are entered on this screen 3 ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross gt Fie Edit Yiew Favorites Tools Help Q v di BLUE CROSS ee N l Poticies Members Partics i Search Personal Data Package Choices Benefit Selection Member Details Insured Details Policy ID 12345 Division 000 COMPANY ABC Owner ABCC System ID 500293428 Main Division Atlantic Regional Group Member Add Insured Details First Name Relationship Date of Birth JOHN Member fi Jan y 1970 Last Name Gender Privacy Consent SMITH Male Yes Continue Cancel Delete Done mEnE a Local intra The screen initially appears as per the figure above If additional insured are to be added the user must click the More Insureds button The screen on the following page will appear Privacy Consent The Privacy Consent field should be flagged to yes If no is selected for the member or any insured on the plan then the employee will not be able to use other web related services offered by Blue Cross This would include the cardholder website and situations where the employee is able to have claims paid directly by their service provider Note If the member or any other insured on the plan does not accept the privacy consent clause as outlined on
60. enefits continued Once the information has been entered the confirmation screen is presented Click Submit to process the changes e ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross File Edit View Favorites Tools Help Ke X ja E _ ronces Members partic a Search General Coverages Services Packages insured Details Details Confirm Policy ID 12345 Division 0009 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293426 JOHN SMITH 500293428 dh BLUE CROSS WELCOME PRIVACY E MAIL HELP LOGOUT Me Member Package Revision Confirm The collection of the enrollment data for this member has been done Please select submit to approve the details Submit Delete Dame Rp Local intra Page 89 of 128 Member Selection Benefits continued Terminating Benefits To terminate a benefit package click the radio button to the left of the benefit being terminated and then click Terminate Package from the blue navigation bar on the bottom of the screen 3 ABCC Enrollment Microsoft Internet Explorer provided by Medayie Blue Cross File Edit View Favorites Tools Help dh BLUE CROSS Policies Members Parties Search Insureds General Benefits Co ordination of Benefits Policy ID 12345 Division 000 9 COMPANY ABC Owner ABCC Atlantic Regional Group WELCOME PRIVACY E MAIL HELP
61. ent Microsoft Internet Explorer provided by Medavyie Blue Cross Fie Edit View Favorites Tools Help ge dh BLUE CROSS WELCOME PRIVACY E MAIL HELP LOGOUT Policies Members Parties eee Search General Co ordination of Benefits HSA Policy ID 12345 Division 0009 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293426 Health Spending Account Contribution Year Current Balance Effective Date Term Date Forfeit Date c 2005 12 01Mar2005 31Dec2005 26Feb2006 2006 12 01Jan2006 31Dec2006 26Feb2007 Add Update Query Delete Done z EE e al Local intra Page 102 of 128 Member Selection HSA continued Add Health Spending Account HSA continued To add HSA for the new year enter the contribution year the deposit amount for the year and the effective date of the deposit The effective date cannot be before the effective date of the benefits Click Save to process the changes E ABCC Enrollment Microsoft Internet Explorer provided by Medayie Blue Cross Fie Edit View Favorites Tools Help 1O z dh BLUE CROSS WELCOMEspeePRIVACY j E MAIL HELP 10G0ur we ll Poticies Members Partics i Search General selection Coverages Services Co ordination of Benefits Policy ID 12345 Division 000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 600293426 He
62. er can be searched for using either the External ID or the System ID number Policy Member Listing A listing of members in the policy can also be retrieved if the user selects the Display Member list option and enters the Policy ID and Division This will return up to a maximum of 250 results Warning Error Messages The user may be presented with error messages or warning messages Most messages will present in red text within the screen the user is working on If there are messages that are not clear please contact the website administration team for direction It is important to understand the message as follow up work may be required Page 23 of 128 Overview of Available Information Once the user has selected the employee s file a series of tabs will be presented below the secondary navigation bar These tabs will differ depending on the tab that is selected from the secondary navigation bar Within each of these tabs is specific information on the employee and their benefits If the user has updating access they will be presented with different options on the bottom bar within each of these screens to submit changes If the user has inquiry only access they will only be able to query the information The figures below illustrate the information on the various tabs dh BLUE CROSS PRIVACY E MAIL rA CACATE le Search Member Selection Coverages Services Miscellaneous Membership Details Member Activity E MAIL HELP
63. ership Details Details Member Activity Policy ID 12345 Division 000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293426 Member Activity Policy ID Division Eff Dt Eff Trans Dt Term Date Term Trans Date Status 12345 000 O10ct2006 17 Nov2006 Transfer Query Page 41 of 128 General Member Activity continued Transfers To transfer an employee to a new policy division the user must first have security access to that policy division If the user does not have access please fax the request to the Blue Cross Customer Administration team for processing To transfer online the user is to select the General Member Activity tab Click transfer from the blue navigation bar on the bottom of the screen The following screen will be presented This takes the user into a workflow to review the current information and benefits and to allow the user to make any necessary changes The user must enter the effective date the new policy and division number and then click the Query button to review the first step of the workflow ABCC Enrollment Microsoft Internet Explorer provided by Medayie Blue Cross Fie Edit Yiew Favorites Tools Help di BLUE CROSS WELCOME PRIVACY E MAIL HELP LOGOUT Poticies Members Portics General Reinstate Transfers Policy ID 12345 Division 0009 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext
64. ery Pone Local intr Page 25 of 128 General Miscellaneous continued Change Member Information To change a member s personal information select General from the navigation bar on the top of the screen and then the Miscellaneous tab Click update in the navigation bar on the bottom of the screen The fields on the screen become editable and can be modified Click the Save button on the navigation bar at the bottom of the screen to submit the changes J ABCC Enrollment Microsoft Internet Explorer provided by Medayie Blue Cross File Edit view Favorites Tools Help dh BLUE CROSS WELCOME PRIVACY E MAIL HELP LOGOUT Potcies Members EPan Search Member Selection Coverages Services Miscellaneous Membership Details Details Member Activity Activity Policy ID 12345 Division 0009 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293428 Update Miscellaneous Name JOHN SMITH Address 123 MAIN STREET ANYWHERE TOWN NB Postal Code Telephone Number s06 555 5555 Effective Date 010ct2006 Paid to Date Policy Series Retention Group Lanquage English Save Cancel oR Local intra Page 26 of 128 General Miscellaneous continued Termination of Coverage To terminate the member s coverage select General from the blue navigation bar on the top of the screen and then the Miscellaneous tab From here select
65. evising Benefits continued Once the information has been entered the confirmation screen is presented Click Submit to process the changes gt ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross Fie Edit View Favorites Tools Help l OO S dih BLUE CROSS WELCOME PRIVACY E MAIL HELP 1OGOUT T r z 4 Potcies Members Porcic gt Sear Coverages Services ch General Packages insured Details Confirm Policy ID 12345 Division 0009 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 5002934268 JOHN SMITH 600293426 Member Package Revision Confirm The collection of the enrollment data for this member has been done Please select submit to approve the details Submit Delete Dome ST B E oaint Page 83 of 128 Member Selection Benefits continued Backdating Benefits The Revise Package option allows the user to either replace or backdate the existing benefit packages that the employee has Selecting the Revise Package option will take the user into a workflow e ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross a T T WELCOME PRIVACY E MAIL HELP dh BLUE CROSS Policies Members Parties Search General Benefits Coverages Services Co ordination of Benefits HSA Policy ID 00891 Division 000 2 SKILLSOFT Owner ABCC Main Division Atlantic Re
66. f benefits status soouse and or dependents the user can click OK in the grey pop up box and submit the request If changes are to be made click the Cancel button on the pop up to continue with the workflow gt ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross File Edit view Favorites Tools Help dh BLUE CROSS WELCOME PRIVACY E roi SAE oe O O OUOU Search Member Selection Coverages Services Reinstate Transfers Packages Policy ID 12345 Division 0009 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293426 JOHN SMITH 500293426 Member Transfers Package Choices Current Employee Classes Packages Medical AA MEDICAL PACKAGE 1 YD This member will be automatically transfered 4 Hospital ne Health Benefits E 5 Drugs Dental AA DENTAL PACKAGE 1 Family Eff Date 010ct2006 9 Dental Life A ALL EMPLOYEES LIFE Eff Date 010ct2006 3 Basic Life 1 Accidental Death amp Dismemberment A ALL EMPLOYEES CRITICAL CONDITIONS Eff Date 010ct2006 C3 Critical Conditions Disability A ALL EMPLOYEES DISABILITY Eff Date 010ct2006 3 Short Term Disability 30 Long Term Disability Continue Cancel Delete El javascript top content continueFunc a we al Local intra Page 44 of 128 General Member Activity continued Transfers continued Once the user clicks Cancel from the pop up on the previous screen they can select new benefit
67. followed Click Save to process changes HSA Effective Date The effective date of HSA would be either the start date of the contribution year or the date in which the employee s benefits went into effect if they became eligible for benefits during the current contribution year HSA Term Date The term date would be a standard date entered since the HSA would be termed for the same time of year for all employees If the employee leaves employment the termination date for HSA in most cases should equal the termination date of benefits Please refer to the contract for details HSA Forfeit Date If the HSA is not used by the Forfeit Date the employee loses the remaining amount in the HSA This date is typically 30 60 or 90 days from the Term Date Please refer to the contract for details E ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross gt Fie Edit View Favorites Tools Help O di BLUE CROSS WELCOME PRIVACY E MAIL HELP LOGOUT Policies Members parties Member Selection Co ordination of Benefits usa Policy ID 12345 Division 000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293426 Health Spending Account Contribution Year 2006 Yearly Deposit 12 a Effective Date fi Jan 2006 Term Date 31 Dec 2006 Forfeit Date 28 Feb 2007 Save Cancel Delete
68. g Once the dependent has reached the date in which they become eligible the user will see that the status below the dependent s name will no longer indicate Regular but it will indicate College University New cards will be issued indicating a termination date of August of the following year adjacent to the student s name The termination date is to remind the member that the student will no longer have coverage at the end of the school year If the student is returning to school and still qualifies for benefits the benefits will need to be reinstated in August of the year indicated on the card J Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross Fie Edit View Favorites Tools Help dih BLUE CROSS Se ee ee i Policies Memes feanen Insureds Co ordination of Benefits HSA Policy ID 12345 Division 000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293428 Insured List Insured Status Eff Dt Eff Trans Date Term Dt Term Trans Dt Family 010ct2006 17Nov2006 Tag Name Gender Date of Birth Age Eff Dt Term Dt T O00 JOHN SMITH Male O1Jan1970 37 010ct2006 Member C 01 JANE SMITH Female 01Jan1970 37 010ct2006 Spouse C 03 JAIME SMITH Female 01Aug1986 20 8 010ct2006 Child Regular Pending Student Pre Registration 02 JOHNNY SMITH Male 01Jun2005 2 010ct2006 Child Regular Addinsured Update Query SY 9 Locate Page 65 of 128
69. ge Choices Health Coverage Options Life Coverage Options M Medical iv Life M Dental M Disability Health Care Province NB Effective Date i Oct y 200 Replace Continue Cancel Delete LT E Local intr Page 85 of 128 Member Selection Benefits continued Backdating Benefits continued If the date entered is prior to the effective date of the plan itself the following error will be presented Click OK to continue e ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross gt Fie Edit view Favorites Tools Help 1O X f ih BLUE CROSS WELCOME PRIVACY E MAIL nep LoGour S Poticies Members Parties e Search General Coverages Services Packages Policy ID 12345 Division 0009 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293426 JOHN SMITH 500293426 Member Package Revision Package Choices Health Coverage Options The Effective Date entered is prior to 2006 10 31 the member s policy join date The member will be backdated i Medical QD M Dental re you sure you wish to submit this as is Health Care Province NB Effective Date 10 y Oct y 2006 Replace Continue Cancel Delete Done fT e Local inte Page 86 of 128 Member Selection Benefits continued Backdating Benefits continued Once the user has clicked OK from the warning message on the previous
70. gional Group Ext ID osoz 11176 SHAWN M QUINLAN 050211176 Benefit Selections Medical C AA MEDICAL PACKAGE 1 Eff Dt Eff Trans Dt Term Dt Term Trans Dt Rating Status Family 4 Hospital 01Sep2003 28Aug2003 F Travel 01Sep2005 26Aug2005 45 Extended Health Benefits 01Sep2005 26Aug2005 10 Drugs 01Sep2003 26Aug2005 Dental C AA DENTAL PACKAGE 1 Eff Dt EffTrans Dt Term Dt Term Trans Dt Rating Status Family 6G Dental O1Sep2005 26Aug2005 Life C rag A ALLEMPLOYEES CRITICAL CONDITION Applied For Eff Dt Eff Trans Dt Term Dt Term Trans Dt Add Coverage Amount Update Coverage Amount Add Package Revise Package Terminate Package Query Ee l a LEE E toca intranet Page 84 of 128 Member Selection Benefits continued Backdating Benefits continued To backdate the package select the package options from the boxes entitled Health Coverage Options and Life Coverage Options where applicable Enter the effective date and then click the grey Backdate button Click Continue to proceed into the workflow A ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross File Edit wiew Favorites Tools Help my dh BLUE CROSS ee E eM no gt Policies Members Partics A Search General Coverages Services Packages Policy ID 12345 Division 0009 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 5002934268 JOHN SMITH 500293426 Member Package Revision Packa
71. he dependent information that was on file at the time of termination will be pre populated on this screen Only additional participants can be added from here by clicking the More Insureds button If the user needs to change or delete the information on file this will be done in a second step once the transfer has been saved See the section on Member Selection Insureds Modifying Insured Details for details on this additional step Click Continue to proceed A ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross Fie Edit Yiew Favorites Tools Help T r dh BLUE CROSS WELCOME PRIVACY E MAIL HELP LOGOUT p Policies Members Portics General Reinstate Transfers Insured Details Policy ID 12345 Division 0009 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293426 JOHN SMITH 500293426 Member Transfers Insured Details First Name Relationship Date of Birth JOHN Member 01Jan2006 Last Name Gender Privacy Consent SMITH Male Yes First Name Relationship Date of Birth JANE Spouse O1Jan1970 Last Name Gender Privacy Consent SMITH Female Yes Marital Status Date First Name Relationship Date of Birth JOHNNY Child 01Jun2005 Last Name Dependent Status Gender Privacy Consent SMITH Regular Male Yes More Insureds Continue Cancel Delete Done CITI amp Local intra Page 46 of 128 General Member Activity continued Transfers continued Once
72. ies a ercentage Irrevocable Update Id O MEDPAT Last Name First Name Relationship Smith Jane Spouse gt Oo OUUU L GI ERREI EINES ERKE EERE Continue Cancel Delete Ee laaa L koanta Page 75 of 128 Member Selection Benefits continued Add Benefits continued Member Details is the next tab presented in the workflow The information on file is presented to the user and can be changed if required A ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross Fie Edit Yiew Favorites Tools Help gk BLUE CROSS pe BER n Poticies Members parties i Search General Coverages Services Packages Beneficiaries member netaits Policy ID 12345 Division O00 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293426 Member Add Member Details Employment Details Occupation Category Senior executive management and professionals Occupation ACCOUNTANT Permanent Employment Date fi vf oct y 2006 Save Cancel LL RQ toca intra Page 76 of 128 Member Selection Benefits continued Add Benefits continued Insured details is the next tab presented in the workflow The current information on file is presented and can be modified if required Click Continue to proceed E ABCC Enrollment Microsoft Internet Explorer provided by Medavyie Blue Cross Fie Edit View Favor
73. in the incorrect effective dates being applied Please forward these requests by fax to be processed manually Assign Effective Date The effective date can be assigned if this field is presented The user is to enter a date that is no more than 31 days in the past or they will be presented with an error Anything that is more than 31 days in the past is to be faxed to the Customer Administration team at Blue Cross for processing Late Applicants If the benefits are going to be late then the wording will be late appears to the right of the benefit If all benefits are late then the wording will be late will appear below the package choices as well This means that our medical underwriting department will notify the employee that a statement of health must be completed to determine if benefits will be approved or declined Date of Signature If Life benefits are assigned the Date of Signature field will be presented and must be completed Enter the date in which the employee has signed the application form Co ordination of Benefits The user must indicate if Co ordination of Benefits is to be assigned by selecting the appropriate radio button beside this option This information will be requested later in the workflow if the user indicates Yes Claim Waiting Period and Late Applicant Status The user cannot alter the claim waiting period it is determined based on whether or not the member is deemed a late applicant If they ar
74. in the last appendices of this document The intent of the guide is to provide users with a brief overview of the site and how to submit some of the more common transactions Quick Reference Guide for Member Inquiry The Quick Reference Guide for Inquiry is included in the last appendices of this document The intent of the guide Is to provide users with a brief overview of the site and where to view some of the more common transactions Page 3 of 128 Signing into the Group Administrator Website Go to the web address provided in the e mail containing your login ID and password Please note that this address is temporary until all clients have been converted and trained to use our new Membership Enrolment System Once the conversion is complete the site will be accessible from our home page by selecting the Group Administrator link Application Menu Once the login ID and password have been entered the Application Menu will be presented The following options are available ES Enrolment This is the option administrators would choose to add change or inquire on benefits for members COV Group Coverage Information If the administrator has been authorized and has requested to view the group contract online this link would be selected to view the contract SUP Supplies Request Form This link is used to request various administration forms INQ Other Group Administrator Inquiries This link is used to e mail requests
75. is working on If there are messages that are not clear please contact the website administration team for direction It is important to understand the message as follow up work may be required Page 7 of 128 Member Add continued Creating the Enrolment Workflow Once the Add Member option has been selected from the blue navigation bar on the bottom of the screen the user will be presented with the first screen of the enrolment workflow Upon completion of each screen the user will select Continue from the navigation bar If at any time the user needs to go back to a previous screen in the workflow they can do so by selecting the appropriate tab Should the user go back to one of the previous tabs the Continue option must be used on each subsequent screen since the required information could change depending on the change made by the user If the enrolment is to be cancelled please use the delete option to remove the application entirely If the enrolment is cancelled and not deleted it sits in an In Progress status to be accessed at a later time Bs ABCC Enrollment Microsoft Internet Explorer provided by Medayie Blue Cross File Edit wiew Favorites Tools Help Q sax z T x B A Search ST Favorites me w X rel 3s ea BLUE CROSS WELCOME PRIVACY E MAIL HELP LOGOUT Poticies Members Products Parties services Search Personal Data Policy ID 12345 Division 0009 COM
76. ision Identification Number 7 a Last Mame EEE oT First Mame Add Member Clear Search Fields Query Page 121 of 128 Common Changes The following highlights the most common changes and where these functions are found within the Member s file For more details on how to process these changes please refer to the User Guide Search Member Selection Coverages Services Miscellaneous Membership Details Member Activity General Miscellaneous Membership Details Member Activity Name Salary Transfers Address Termination Reinstatement Search General Coverages Services Insureds Co ordination of Benefits Member Selection Insureds Benefits Status single family Benefits Displayed With History Spouse add update Add Update Coverage Amount Dependent add update Add Revise Terminate Benefits Page 122 of 128 Summary of Eligibility Options for Members with Existing Benefits Search Member Selection Coverages Services General Miscellaneous Membership Details Member Activity Name Employment Details Transfers Address Salary Termination Reinstatement Search General Coverages Services Insureds Co ordination of Benefits Member Selection Insureds Benefits Co ordination of Benefits Beneficiaries H S A Status single family Benefits Displayed With History Add Update COB Update Beneficiary Displays Details Spouse add update Add Update Coverage Amount Add Change HSA Dependent add update Add
77. ites Tools Help e mS a dh BLUE CROSS WELCOME PRIVACY E MAIL eL woGoUT 5 votes RBRBRAE vores eric ll General Coverages Services Packages Beneficiaries Member Details insured Details Policy ID 12345 Division 000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 600293426 Search Member Add Package Insured Details First Name Relationship Date of Birth SHAWN M Member 01Jan1970 Last Name Gender Privacy Consent SMITH Male Yes First Name Relationship Date of Birth JANE Spouse 01Jan1970 Last Name Gender Privacy Consent SMITH Female Yes Marital Status Date First Name Relationship Date of Birth JOHNNY Child 01Jun2005 Last Name Dependent Status Gender Privacy Consent SMITH Regular Male Yes Continue Cancel Delete oR Loca intra Page 77 of 128 Member Selection Benefits continued Add Benefits continued Once all the information has been reviewed and updated the Confirmation screen is presented Click Submit to process the changes 2 ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross File Edit wiew Favorites Tools Help dh BLUE cross WELCOME PRIVACY E MAIL HELP LOGOUT Po ee AEA O OOOO OUUU Search General Coverages Services Member Details insured Details Confirm Policy ID 12345 Division 000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 5
78. its for members Se BLUE CROSS E venu Ooue Welcome to the Application Menu You have access to the following applications Chick On E Enrolment ES Guide Enrollment User Guide COW Group Coverage Information SUP supplies Request Form ING Other Group Administrator Inquires Page 118 of 128 The user will then be presented with a Welcome Page from which they need to select the Members option The Members tab will allow the user to access the Search and Add New Member functions Ji BLUE CROSS Parties Welcome to Group Administrator Services Group Administrator Services gives you the opportunity to View policy lists to locate your specific policy Perform memberspecitic transactions such as adding a new member or dependent or changing address or benefits Perform member searches to locate a specific member of a policy and or view member information Once the Members tab has been selected a secondary navigation bar is presented To begin any work ie enrolments or changes to existing eligibility the user must start with the Search tab Poticies Members rarcics General Member Selection Coverages Services Page 119 of 128 Enrolling Members for Benefits For the purpose of adding benefits for a member select the radio button beside Name Complete the fields for Policy ID Division Last and First Name Select the Add Member option from the blue navigation bar on the bo
79. l Delete CLL oaint Page 60 of 128 Member Selection Insureds continued Terminating a Participant with a Resulting Change to Status Please follow the steps as outlined in the section entitled Changing to Single Status Surviving Spouse Benefits To apply surviving spouse benefits please forward the request to the administration team at Blue Cross for manual processing Updating Member or Dependent Information To modify details on the member or any participants click the box to the left of the individual s name and then click Update from the blue navigation bar on the bottom of the screen ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross Fie Edit View Favorites Tools Help hye gk BLUE CROSS WELCOMEsneRAIVACY E MAIL HeLp_ 10G0Ur ames er lil Policies Members Parcics ee Search General Coverages Services Co ordination of Benefits Beneficiaries HSA Policy ID 12345 Division J000 9 COMPANY ABC Owner ABCC r Insureds Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293426 Insured List C Insured Status Eff Dt Eff Trans Date Term Dt Term Trans Dt Family 010ct2006 17Nov2006 Tag Name Gender Date of Birth Age Eff Dt Term Dt MY 00 JOHN SMITH Male O1Jan1970 36 010ct2006 Member E 01 JANE SMITH Female 01Jan1970 36 010ct2006 Spouse T 02 JOHNNY SMITH Male 01Jun2005 1 010ct2006 Child Regular Addinsured Update Que
80. le life benefits these options still need to be selected so that the appropriate packages are displayed Page 10 of 128 Member Add Package Choices continued Calculating the Effective Date One of two options will be displayed in this instance depending on the terms of the contract for the selected policy and division A grey button entitled Calculate Eff Date is the most common scenario and will appear below the box containing the package choices The other option is a field entitled Assign Eff Date where the user can enter the effective date of coverage Calculate Effective Date Click on the Calculate Effective Date button to display the effective date of coverage If there are multiple probationary periods for the options that are grouped together the earliest date will be displayed When the ID is assigned it will calculate the correct dates for each line of benefit For example if the employee is eligible for Travel the day they are hired but their Hospital Extended Health and Drug benefits are not effective until three months following employment the date displayed beside Health will be equivalent to the Travel benefits effective date When the card is issued the correct dates will be on the back of the card in the cases where benefit descriptions are printed on the cards Below the Calculate Effective Date button is a field entitled Override Effective Date Please do not use this option as it may result
81. lection Benefits continued Add Benefits continued From the previous screen once the grey List Available Packages option is selected those benefits that can be selected based on the criteria entered are listed The user is to select the radio button to the left of the benefit being added and then enter any amount if applicable In some cases as per the terms of the contract the administrator will need to indicate if the applicant is late or not If Late Applicant is to be flagged with a Yes then the information should be faxed to the Customer Administration team at Blue Cross so that appropriate steps can be followed by the Medical Underwriting team Click Continue to proceed to the next phase of the workflow Page 73 of 128 Member Selection Benefits continued Add Benefits continued Once the user clicks the Continue button they are presented with a reminder message to ensure that the Claim Waiting Period and Late Applicant Status have been reviewed Click OK to continue or Cancel to go back and modify the information ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross File Edit View Favorites Tools Help Ke ja E MAIL HELP LOGOUT Ta dh BLUE CROSS WELCOME PRIVACY E Lv Policies ce ornare Parties cS Coverages Services om Packages Policy ID 12345 Division 000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 50
82. licies Members Parties General Member Selection Coverages Services Member Search Active Active and Terminated Search by external identification number alternate identification number system identification number name Policy ID i2345 Distr 000 Identification Murnber Last Mame Smith First Name Jonn Book of Business il Display member list Policy ID za Division 4 Add Member Clear Search Fields Query i Page 6 of 128 Member Add continued If a member with the same name exists within the policy number entered they will be presented This feature is available because the member may require benefits to be reinstated instead of a new enrolment The member s name may also appear with the wording In Progress below their name Had the administrator already started to key a new enrolment and was not able to complete it the partial enrolment will be saved the terminology In Progress will be below the name Simply click on the link and continue the enrolment If the names presented in the listing are different from that which the administrator is enrolling then the user would not click on any of the links simply click the Resume Member option from the navigation bar on the bottom of the screen Warning Error Messages The user may be presented with error messages or warning messages Most messages will present in red text within the screen the user
83. m Disability 010ct2006 17 Nov2006 30 Long Term Disability 010ct2006 17 Nov2006 Add Coverage Amount Update Coverage Amount Add Package Revise Package Terminate Package Query Done zz x xz a Local intra Page 93 of 128 Member Selection Benefits continued Benefits Summary continued Once the grey Benefits Summary button has been selected the benefit information will be presented in the format below This summarizes the effective termination and transfer dates by line of benefit so the user can easily view the history on the benefits 3 ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross Fie Edit Yiew Favorites Tools Help dh BLUE CROSS EE Ly veue socour ea Poticies Members Parties ee Search General Coverages Services Policy ID 12345 Division 0009 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293426 JOHN SMITH 500293426 oane 4 Hospital 17 Nov2006 1 Life Disability Extended Health Benefits 17 Nov2006 C Critical Conditions 17 Nov2006 S E Plan C3 16Nov2006 en Long Term Disability 17 Nov2006 Plan 30 16Nov2006 Short Term Disability 17 Nov2006 Return 2 Dome Rp Local ite Page 94 of 128 Member Selection Co ordination of Benefits Ly HELP a y dh BLUE CROSS a Poticies Members parties a Co ordination of Benefits HSA Within the Member Selection Co ordination of Benefits tab
84. mount and either backdate the effective date or leave it the same as the date on file If the effective date is to be greater than the current date on file the Add Coverage Amount option must be used Please refer to the previous section on Member Selection Benefits Add Coverage Amount Note The effective date can be no more than 12 months in the past Click Save to process the changes 3 ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross Fie Edit Yiew Favorites Tools Help Ke a em dh BLUE CROSS WELCOMEsjePRIVACY j E MAIL HELP 10GoUT a ll Poticies embers Products Partics Search General i Coverages Services Benefits Co ordination of Benefits HSA Policy ID 12345 Division 000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293426 Benefit Selections Employee Class A Package ALL EMPLOYEES OPTIONAL SPOUSE LIFE Coverage Applied For Eff Dt 1 Optional Spouse Life 50000 fi y Sep y 2001 Save Cancel Ee O L E E Boana Page 70 of 128 Member Selection Benefits continued Add Benefits To add a benefit that is not already in effect for the employee go to the Member Selection Benefits tab and click Add Package from the blue navigation bar on the bottom of the screen This will take the user into a workflow e ABCC Enrollment Microsoft Internet Explorer provided by Medavie
85. n The contract may stipulate that the dependent is covered until their birthday the end of the month or the end of the year in which they reach this age If the dependent is continuing their education and qualifies as a student the user now has the option to pre register them as a student 60 days prior to the date in which they become eligible To pre register a student check the box to the left of the student s name and click Update in the navigation bar on the bottom of the screen Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross File Edit View Favorites Tools Help gt cra dh BLUE cROsS WELCOME PRIVACY E MAIL HELP LOGOUT rss S gt O Search General Coverages Services Insureds Co ordination of Benefits Policy ID 12345 Division 000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293426 Insured List C Insured Status Eff Dt Eff Trans Date Term Dt Term Trans Dt Family O010ct2006 17 Nov2006 Tag Name Gender Date of Birth Age Eff Dt Term Dt C OO JOHN SMITH Male O1Jan1970 37 010ct2006 Member C 01 JANE SMITH Female 01Jan1970 37 010ct2006 Spouse M 03 JAIME SMITH Female 01Aug1986 20 8 010ct2006 Child Regular E 02 JOHNNY SMITH Male 01Jun2005 2 010ct2006 Child Regular Add Insured Update Query javascript top uSubmit MemberSelectionInsuredsList memberSelectionsInsuredsListInquiry Fi iz Fi i te Lo
86. n y 1973 Type of Coverage All Family Vision Hospital gt Drugs Extended Health Benefits Dental Insureds All C Spouse C List Specific Insureds a Continue Cancel Delete amp e C EEE B E Local intra Page 15 of 128 Member Add Member Details The Member Details screen allows the user to enter details on occupation and salary Where applicable the Health Spending Account information is also added using this screen SY Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross Fie Edit View Favorites Tools Help O gt hd ae dh BLUE CROSS WELCOME PRIVACY E MAIL HELP LOGOUT Poticies Members Parties Member Details Policy ID 12345 Division 0009 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293426 Member Add Member Details Alternate ID 1 Alternate ID 2 Employment Details Occupation Category gt Occupation SIN Salary Information Construction Trades Hospitality Occupations Foreman in Production and Manufacturing Health and Education High Risk Occupations Labourers and Heavy Equipment Operators Management Supervisory and Technical staff Office and Clerical staff Production Manufacturing Short Haul deliverymen sales and Service Field Technicians 7 Salary Frequency Hours per week COo OSTO MU M Health Spending Account
87. nd the 31 day limitation must be sent to Blue Cross for manual processing since a claim check is required for those participants who are being terminated ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross File Edit wiew Favorites Tools Help Ke Sa ja r dh BLUE CROSS WELCOME PRIVACY E MAIL HELP LOGOUT Poticies Members Paice Member Selection Insureds Benents co ordination of Benefits Benefits Beneficiaries usa Policy ID 12345 Division 0009 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293426 JOHN SMITH 500293426 Insured List Insured Status Single Status Eff Dt fi Oct 2006 Tag 01 Relationship Gender Date of Birth Term Dt First Name Jane Spouse Female 1 y Jan y 1970 30 y Sep 2006 gt Last Name SMITH Tag 02 Relationship Gender Date of Birth Term Dt First Name JOHNNY Child Male gt E Jun y z005 30 Sep 2006 gt Last Name SMITH Dependent Status Regular Save Cancel Delete LL E oaint Page 50 of 128 Member Selection Insureds continued Changing to Single Status continued Once the user has saved the changes from the previous screen they will be brought back to the Original screen and the changes will be displayed gt ABCC Enrollment Microsoft Internet Explorer provided by Medayvie Blue Cross gt File Edit View Favo
88. nging to Single Status cccccfcccefosccdccvcccasdsaeiesveeeni eed wecd aadiacben etee aacdceeddianeeudiedidaseees 49 Changing to Family Status cccccccsssssscceeeccceeesssseeeeceseeeaseeeeeeeeeeeeaaseeeeeeessssaasseeeess 52 Changing to Family Status and Reinstating Participants cceeeeeeeeeeeees 54 Adding a Participant to a Family plan Spouse or Dependen cseeeeeeeees 57 Terminating a Participant with no Resulting Change to Status cee 59 Terminating a Participant with a Resulting Change to Status cece 61 Surviving Spouse Benefits ccccccccecccceccceaeeseeeeeeeesaeeeeeeeeeeeeesaaaeseeeeeeeesseaaseeseeeees 61 Updating Member or Dependent Information 0 cece cece cseeeeeeeeeaeeeeeeeaeeeeeesaaeees 61 Student Pre Registration iis oso cst Sars ate ewe ee crt cid entiaisa oatadice taatenaiaesd Gducentonad anes 63 Add Coverage Amount Optional Life Benefits Only 0 oc ceeeeeeeeeeeeeeees 67 Update Coverage Amount Optional Life Benefits Only 0 ec eeeeee eee e ees 69 Add BENEI S a eae a a erate ene ere a mee ener eee ee meee ear 71 Revising CIO MS asst ce satin set a E doses ane Gan tana cavanuses a a 79 BAG ICAU INC Benefits ecra n e a eee 84 TERMINATING Benefits ersen OE EEE 90 Benefits SUMMA ea a sc a a a a 93 Co ordination of BGO nits sisi cosa eos oo ceeadecnac ass ected eee eee ee
89. ns Dt 3 Basic Life 010ct2006 17Nov2006 1 Accidental Death amp Dismemberment 010ct2006 17Nov2006 Add Coverage Amount Update Coverage Amount Add Package Revise Package Terminate Package Query CL YT koanta Page 66 of 128 Member Selection Benefits continued Add Coverage Amount Optional Life Benefits Only This option applies only to Optional Life Optional Spouse Optional Child Critical Conditions and Optional AD amp D benefits To change the amount or to enter a new effective date greater than the date on file the user would select the radio button to the left of the life option to be updated and then click the Add Coverage Amount option from the blue navigation bar on the bottom of the screen Note To backdate or to change the amount without changing the effective date please see the section on Update Coverage Amount Optional Life Benefits Only e ABCC Enrollment Microsoft Internet Explorer provided by Medavyie Blue Cross File Edit View Favorites Tools Help pewecross isis e E BLUE CROSS WELCOME PRIVACY E MAIL HELP LOGOUT o Benefits Policy ID 12345 Division 000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293426 Benefit Selections Medical MEDICAL PACKAGE 1 Eff Dt EffTrans Dt Term Dt Term Trans Dt Rating Status Family 4 Hospital 01Sep2003 26Aug2003 F Travel 01Sep20035 26Aug2003 45 Extended Heal
90. ntra Page 27 of 128 General Miscellaneous continued Reinstatement of Benefits Please refer to the contract to ensure that the rules for reinstatements are followed For example if the Health and Dental benefits were termed more than one year in the past a new application may be required To reinstate the member s coverage select General from the blue navigation bar on the top of the screen and then the Miscellaneous tab From here select Reinstate from the navigation bar on the bottom of the screen Selecting the reinstatement option will begin a workflow to enable the user to review the previous coverage and information and make appropriate changes Reinstate Transfer is the first screen in the workflow Enter the effective date of the reinstatement and click on the Query button The ID can also be transferred to a new policy and or division by entering the information in the appropriate fields If the user is reinstating and transferring in the same step please follow the workflow outlined in the General Member Activity Transfer section of this document To continue with the reinstatement click Query to display additional information 3 ABCC Enrollment Microsoft Internet Explorer provided by Medayie Blue Cross File Edit Yiew Favorites Tools Help _ gt di BLUE CROSS WELCOME PRIVACY E MAIL HELP LOGOUT el Poticies Members Partics a General Reinstate Transfers Policy I
91. oe eR 96 21216021 1 ef lt 1 eel CO SU See re ee ee ee nee eee eee 99 Add Health Spending Account HSA ccccccccccccceeeceeeeeeeeeeeeeesaeeeeeeeeeeessaaaaeeeeeees 102 Update Health Spending Account HSA ccccccccccccceeeeaeeeeeeeeeeecaaeeeeeeeeeeessaeaaeees 104 Delete FSA esate eae eee cet eee ee 106 Benefit DESCHIPUONS sonir a a E E nin 109 Requesting an Identification Card ccc ccccccccecceeeeeeeceeeeeseeeeeeeeeeeesssaeaeeeeeeeeeeeaaas 111 Member Updates 4 iie hale ee cece ae ee ee 115 D leting Changes xcs as sheds cece ee ee ee 116 APPEND A a tines Aeuasaate a oh e esata de sala a ole ta eons esate oral eir niin 117 Quick Reference Guide for Member Enrolment and Updates cceeeeseeeeeeeees 117 APPENDIX Bees eco aerate nei esses eee 124 Quick Reference Guide for Member Inquiry 0 cccccccceeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeees 124 Page 2 of 128 Introduction The User Guide is intended to provide the user with an overview of the Group Administrator Website It includes the majority of transactions that the user would require to administer their Blue Cross benefits online Users can review the various transactions in detail within the content of this document A Quick Reference Guide is also available at the end of this document Quick Reference Guide for Member Enrolment and Updates The Quick Reference Guide for Member Enrolment and Updates is included
92. on Note Users with inquiry only access will only be able to view the above information g ABCC Enrollment Microsoft Internet Explorer provided by Medayie Blue Cross File Edit View Favorites Tools Help aa n dh BLUE CROSS WELCOME PRIVACY EMAIL HELP LOGOUT P5 Policies Members Parties el Search General Coverages Services insureds HSA Policy ID 12345 Division J000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293428 Pending Insured List I Insured Status Eff Dt Eff Trans Date Term Dt Term Trans Dt Family 010ct2006 1 Nov2006 Tag Name Gender Date of Birth Age Eff Dt Term Dt O 00 JOHN SMITH Male O1Jan1970 36 010ct2006 Member C 01 JANE SMITH Female 01Jan1970 36 010ct2006 Spouse O 02 JOHNNY SMITH Male 01Jun2005 1 010ct2006 Child Regular Addinsured Update Query Done ITIITI amp Local intra Page 48 of 128 Member Selection Insureds continued Changing to Single Status The following outlines the steps to change the rating status from a greater rating status to a lesser rating status ex family status to couple or single status or couple status to single status Once the user has accessed the employee s information they are to select the Member Selection Insureds tab The following screen will be presented Click on the box to the left of the Insured Status title and then click on the box or boxes to the left of the
93. on above the listing of insureds If the participant being added was previously on the plan it is important that they are not entered a second time for claim purposes A ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross File Edit View Favorites Tools Help WELCOME PRIVACY E MAIL HELP LOGOUT dh BLUE CROSS een Poticies Members Partics Search General Coverages Services Insureds Co ordination of Benefits Policy ID 12345 Division 000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293428 Pending Insured List M Insured Status Eff Dt Eff Trans Date Term Dt Term Trans Dt Single 010ct2006 Tag Name Gender Date of Birth Age Eff Dt Term Dt rT O00 JOHN SMITH Male O1Jan1970 36 01 0ct2006 Member Addinsured Update Query CL TL Rg Local intra Page 54 of 128 Member Selection Insureds continued Changing to Family Status and Reinstating Participants continued From the previous screen once the history is displayed click on the box to the left of the Insured Status and click on the names of those participants who are being reinstated If additional dependents are to also be added please follow the steps as outlined in the section entitled Adding a Participant to a Family plan Spouse or Dependent after the steps to reinstate the previous participants have been saved
94. or the following screen to appear Enter the revised salary information and then click Save Note lf an hourly rate is entered then the number of hours must also be entered in the Hours per Week field A ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross File Edit Yiew Favorites Tools Help T Ja dh BLUE CROSS WELCOME PRIVACY E MAIL HELP LOGOUT o aaa Poticies Members artic General Membership Details Policy ID 12345 Division 0009 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293428 Update Membership Details Salary Information Hours salary Frequency per Week Eff Dt 65000 00 Yearly gt f Oct 2006 Save Cancel G EEEE E koanta Page 40 of 128 General Member Activity dh BLUE CROSS Policies Members Parties Search Member Selection Coverages Services Membership Details Member Activity Banking Within the General Member Activity tab the user will be able to View the history of transfers and reinstatements Transfer the member to another policy division Note Users with inquiry only access will only be able to view the above information A ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross Fie Edit View Favorites Tools Help dh BLUE CROSS Poticies Members Parties M Member Selection Coverages Services n Memb
95. p dh BLUE CROSS WELCOME PRIVACY E MAIL weL Locour 5 Policies ra M Parties _ Coverages Services Insureds Co ordination of Benefits HSA Policy ID 12345 Division 0009 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293426 Insured List Insured Status Family gt Status Eff Dt E y Oct 2006 gt Tag 01 Relationship Gender Date of Birth Term Dt First Name J aNE Spouse gt Female fi Jan 1970 Day Month y Vear gt Last Name SMITH Tag 02 Relationship Gender Date of Birth Term Dt First Name JOHNNY Child gt Male fi Jun y z005 Day Month VYear Last Name SMITH Dependent Status Regular gt Save Cancel Delete CTL Re Loca intra Page 56 of 128 Member Selection Insureds continued Adding a Participant to a Family plan Spouse or Dependent To add another participant to a plan that is already family status go to the Member Selections Insureds tab and select Add Insured from the blue navigation bar on the bottom of the screen E ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross File Edit View Favorites Tools Help Ke X a dh BLUE CROSS WELCOMEsjePRIVACY E MAIL HELP 10GOUT e pa nme voces SESE ell Search General Coverages Services insureds Benefits Co ordination of Benefits Beneficiaries nsa Policy ID 1
96. packages or reselect the current package if the package is not changing If there is a change to the status the Rating Status can be changed in this screen For example if the ID is going from Single to Family then select Family from the dropdown boxes to the right of the rating status Click Continue to proceed through the workflow E ABCC Enrollment Microsoft Internet Explorer provided by Medayie Blue Cross File Edit wiew Favorites Tools Help dh BLUE CROSS Se n E Policies members Parties Search enera Member Selection Coverages Services Packages Policy ID 12345 Division 0009 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293426 JOHN SMITH 600293426 lf packages have rating status s marked with a they must have the same value Medical AA MEDICAL PACKAGE 1 Mandatory 5 Drugs Health Care Province NB Rating Status Family 1 Extended Health Benefits TREPA m Waive Reason m J F Travel 4 Hospital Dental AA DENTAL PACKAGE 1 Mandatory 9 Dental Health Care Province NB Rating Status Family gt Waive m Waive Reason gt select a Life Coverage Option Life A ALL EMPLOYEES LIFE Mandatory Waive C Waive Reason 3 Basic Life 1 Accidental Death amp Dismemberment Continue Cancel Delete Henge ec Page 45 of 128 General Member Activity continued Transfers continued Insured Details is the next tab in the Transfer Workflow T
97. ption If the effective date being entered is greater than the effective date of the current salary the user would select the Add function from the navigation bar on the bottom of the screen E Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross File Edit Yiew Favorites Tools Help _ a dh BLUE cross WELCOME joPRIVACY E MAIL HELP IOGOUT a i Policies Members ries Search Member Selection Coverages Services Membership Details Member Activity Policy ID 12345 Division 0009 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293428 Membership Details C Employment Details Occupation Category Senior executive management and professionals Occupation ACCOUNTANT Permanent Employment Date 010ct2006 Cross References Alternate ID 1 Alternate ID 2 Previous Membership Salary Information Hours Calculated salary Frequency perVVeek Eff Dt Eff Trans Dt Term Dt Term Trans Dt Annual Salary 65 000 00 Yearly 010ct2006 17 Nov2006 65 000 00 Add Update Query Done fi mz ri EA z a Local intral Page 38 of 128 General Membership Details continued Add Salary Information If there is no salary information on the screen and the Add option from the navigation bar on the bottom of the previous screen was selected the following screen will appear Enter the appropriate information and then select Save from the navig
98. r printed on the identification card is to be assigned by the user as per the conditions of the contract a field entitled Alternate ID will be presented as the first field on this screen The field must contain nine characters Please front fill with zeros if the number being assigned is not this length Click Continue from the navigation bar on the bottom of the screen to proceed Bs ABCC Enrollment Microsoft Internet Explorer provided by Medayie Blue Cross Fie Edit Yiew Favorites Tools Help Q sx Q x B FN pO search ST Favorites O ir w LJ rel 3 dh BLUE CROSS WELCOME PRIVACY E MAIL HELP LOGOUT Ponies Oe Products aries services Search Personal Data Policy ID 12345 Division 0009 COMPANY ABC Owner ABCC System ID 500293428 Main Division Atlantic Regional Group Member Add Member Personal Data Enrollment C Initial Subsequent External ID 500293426 Last Name smith First Name onm OO O Address 123 Main Street anywhere Town NB s s s sSOSOCCS To TTT Postal Code Telephone Number s06 555 5555 Health Care Province NB gt Language English gt Permanent Date Employed io ffoct z006 Continue Cancel Delete Done Sh a Local inti Page 9 of 128 Member Add Package Choices Package Choices are displayed as the second tab of the enrolment workflow The user will select the type of packages that the employee ha
99. rites Tools Help Ke z WELCOME PRIVACY E MAIL HELP LOGOUT 4 ge BLUE CROSS CACT Search General Coverages Services insureds Benenits co ordination of Benefits of Benefits Beneficiaries nsa Policy ID 12345 Division 000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293428 Insured List C Insured Status Eff Dt Eff Trans Date Term Dt Term Trans Dt Single 010ct2006 Tag Name Gender Date of Birth Age Eff Dt Term Dt O 00 JOHN SMITH Male 01Jan1970 0 010ct2006 Member Addinsured Update Query LL koant Page 51 of 128 Member Selection Insureds continued Changing to Family Status The following outlines the steps to change the rating status from a lesser rating status to a greater rating status ex single status to couple or family status or couple status to family status Once the user has accessed the employee s information they are to select the Member Selection Insureds tab The following screen will be presented Note If there are grey buttons on the screen that state Show History please click the grey button If any of the participants listed in the history are to be reinstated please refer to the section entitled Changing the Rating Status to Family and Reinstating Participants It is important the participants are not entered a second time for claim purposes Click on the box to the left of the Insured Sta
100. ry LT Eiane Page 61 of 128 Member Selection Insureds continued Updating Member or Dependent Information continued Once Update has been selected from the previous screen the user is able to edit any of the fields below Click Save to process the change Note If the user is applying Surviving Spouse to the plan the information is to be faxed to the Blue Cross administration team Please do not enter this on the website ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross Fie Edit Yiew Favorites Tools Help E I dh BLUE CROSS WELCOMEsePRIVACY E MAIL J HELP 1 10Gour i _ _ AE OUOU Search General Coverages Services insureds Co ordination of Benefits HSA Policy ID 12345 Division 0009 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293426 JOHN SMITH 600293426 Insured List Insured Status Family Status Eff Dt 010ct2006 Tag 00 Relationship Gender Date of Birth Term Dt First Name JOHN Member gt Male gt E Jan y 1970 Day Month y Vear gt Last Name SMITH Save Cancel Delete Ebe a LE B Local intra Page 62 of 128 Member Selection Insureds continued Student Pre Registration When a dependent reaches a specific age as defined in the contract they are no longer eligible for benefits unless they are continuing their education at a recognized post secondary institutio
101. s First Name Relationship Date of Birth Jane Spouse fi Jan y 1972 Last Name Gender Privacy Consent smith Female gt Yes gt Marital Status Date Day Month First Name Relationship Date of Birth Child Day Month Last Name Dependent Status Gender Privacy Consent Continue Cancel Delete Done a 3 Local intra Page 32 of 128 General Miscellaneous continued Reinstatement of Benefits continued Once the user clicks Continue on the previous screen the following confirmation screen will be presented The user must click Submit in order to save the changes If at any time during the workflow the user wants to cancel the reinstatement they can click Delete from the bottom navigation bar A ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross gt Fie Edit wiew Favorites Tools Help 1O Sg dh BLUE CROSS WELCOME j PRIVACY E MAIL HELP LOGOUT To oaan Policies Members l fkEPoneO Search Member Selection Coverages Services Reinstate Transfers Packages insured Details Details Confirm Policy ID 12345 Division 000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293426 Member Reinstate Transfers Confirm The collection of the enrollment data for this member has been done Please select submit to approve the details Submit Delete a Page 33 of 128 Gener
102. s requested Specifics of the packages will be presented further into the enrolment 3 ABCC Enrollment Microsoft Internet Explorer provided by Medayie Blue Cross File Edit View Favorites Tools Help Q Back gt r x a A a Search Se Favorites amp E wil rel ry g dh BLUE CROSS a o i Poiicies Members Products Parties services Ieee Search Personal Data Package Choices Policy ID 12345 Division 000 COMPANY ABC Owner ABCC system ID 500293428 Main Division Atlantic Regional Group Member Add Package Choices Health Coverage Options Life Coverage Options M Medical O1Jan2007 M Life O1Jan2007 M Dental 01Jan2007 M Disability 01Jan2007 Your Effective Date will be 01Jan2007 Date of Signature fi y Oct y 2006 Co ordination of Benefits Yes No Claim Waiting Period C Applied Waived Late Applicant Yes No Continue Cancel Delete Done CITIT Local intra Benefits Benefits are presented on this screen in general terms specific options are presented in the screens to follow Place a check mark in the benefits required by clicking in the boxes to the left of the benefit For the Life Coverage Options all options except for weekly indemnity Short Term Disability and Long Term Disability are grouped as Life Long Term Disability and Short Term Disability are grouped together as Disability If the employee is applying for one life benefit or all availab
103. screen the current package and available packages are presented Select the appropriate package and click Continue to proceed BY ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross File Edit Yiew Favorites Tools Help ne a a dh BLUE CROSS WELCOME Er J Help soGour P Poticies Mamoe Partics I Search General Coverages Services Packages Policy ID 12345 Division 0009 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293426 JOHN SMITH 500293426 Member Package Revision Package Choices Life Coverage Options Life I Disability Health Coverage Options M Medical M Dental Health Care Province NB Effective Date 10 Oct y 2006 Replace _ Current Employee Classes Packages Medical AA MEDICAL PACKAGE 1 Family Eff Date 310ct2006 4 Hospital F Travel 1 Extended Health Benefits 5 Drugs Dental AA DENTAL PACKAGE 1 Family Eff Date 310ct2006 9 Dental Life A ALL EMPLOYEES LIFE Eff Date 310ct2006 3 Basic Life 1 Accidental Death amp Dismemberment Available Employee Classes Packages Select a Health Coverage Option C Medical AA MEDICAL PACKAGE 1 Mandatory 4 Hospital Health Care Province NB Rating Status Family F Travel 1 Extended Health Benefits 5 Drugs Dental AA DENTAL PACKAGE 1 Mandatory 9 Dental Health Care Province NB Rating Status Family Continue Cancel Delete TT Elantra Page
104. select a category that is closest to the descriptions provided and then enter a more detailed description in the text field entitled Occupation Click Save to submit the changes Enrollment Microsoft Internet Explorer provided by Medayie Blue Cross File Edit Yiew Favorites Tools Help e p dh BLUE CROSS WELCOMBsjsPRIVACY E MAIL HELP 1 10GOUT et ill Policies Members patics Ts Search Member Selection Coverages Services Membership Details Member Activity Policy ID 12345 Division 0009 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293426 JOHN SMITH 500293426 Update Membership Details Employment Details Occupation Category All gt Construction Trades Hospitality Occupations Painter carpenter installer builder journeymen bartender waiter housekeeping Foreman in Production and Manufacturing Supervisory role with no operational duties Health and Education Nurse teacher social worker personal care worker nurse s aide counsellor High Risk Occupations Policeman fireman airline pilot religious representatives artists Labourers and Heavy Equipment Operators Janitor warehouseman security guard shipper truck driver cleaner farmer driller labourer Management Supervisory and Technical staff Managing clerical and office personnel analyst programmer consultant field professionals Office and Clerical staff Bookkeeper accounting clerk secre
105. st C Insured Status Eff Dt Eff Trans Date Term Dt Term Trans Dt Family 010ct2006 17Nov2006 Tag Name Gender Date of Birth Age Eff Dt Term Dt C O00 JOHN SMITH Male O1Jan1970 36 01 0ct2006 Member Mo O01 JANE SMITH Female O1Jan1970 36 01 0ct2006 Spouse T O02 JOHNNY SMITH Male 01Jun2005 1 010ct2006 Child Regular Add Insured Update Query Done ea a Local intra Page 59 of 128 Member Selection Insureds continued Terminating a Participant with no Resulting Change to Status continued Once Update has been selected from the previous screen the following screen will be presented Enter the termination date by selecting the appropriate information from the dropdown bars Click Save to process the changes E ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross gt Fie Edit View Favorites Tools Help 1O X dh BLUE CROSS WELCOME PRIVACY E Policies Members Parties Search General Coverages Services Insureds Benefits co ordination of Benefits of Benefits Beneficiaries nsa Policy ID 12345 Division D009 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293426 JOHN SMITH 500293428 Insured List Insured Status Family Status Eff Dt 010ct2006 Tag 01 Relationship Gender Date of Birth Term Dt First Name J aNE Spouse gt Female gt fi Jan v 1970 E Nov 2006 gt Last Name SMITH Save Cance
106. sted Replacement Card Query Submit LL Rp boca int Page 110 of 128 Services Request ID Card continued Requesting an Identification Card To request an ID card select the Services Request ID tab Check the box to the left of the Request Identification Card field and click Submit to process the request Note Cards are automatically produced for all changes except for Reinstatements and Address Changes A ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross Eile Edit view Favorites Tools Help Q sack d v x E TN JO search 5 Favorites O 2 w id rel 33 dh BLUE CROSS Policies Members Products Partics i Request ID _ Activity Details updates Policy ID 12345 Division J000 9 COMPANY ABC Owner ABCC WELCOME PRIVACY E MAIL HELP LOGOUT Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293426 Services Request Identification Card History of Card Generation Date Produced Source Reason 20Jul2006 System Generated Replacement Card O7Jul2006 Card Requested Replacement Card Query Submit pL N Local int Page 111 of 128 Services Activity Details dh BLUE CROSS Poticies Members Parties a M Search General Member Selection Coverages Request ID Activity Details Updates Within the Services Activity Details tab the user will be able to View a history of changes to rating statuses and polic
107. t Internet Explorer provided by Medayie Blue Cross File Edit view Favorites Tools Help ne a Sy e on dh BLUE CROSS SS _ MAIL HELP LOGOUT _ 3 T Policies Members parties ee Search General Coverages Services Co ordination of Benefits Beneficiaries HSA Policy ID 12345 Division J000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293426 Beneficiaries Name Relationship Percentage Irrevocable Update ld Update Date Jane Smith Spouse 100 No MEDPA1 17Nov2006 Update Query CT LT p bocal intra Page 98 of 128 Member Selection Beneficiaries continued Beneficiaries To view or make changes to beneficiary information the user would select the Member Selection Beneficiaries tab To make changes select Update from the blue navigation bar on the bottom of the screen B ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross Fie Edit view Favorites Tools Help dh BLUE CROSS WELCOMBsmeenaiUNGY EMAIL 1cL gt _1 10G0Ur amos 3 ma Policies Members Partics I Search General Coverages Services Co ordination of Benefits Beneficiaries HSA Policy ID 12345 Division 000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293426 Beneficiaries Name Relationship Percentage Irrevocable Update ld Update Date Jane Smith
108. tary customer service representative administrative service Production Manufacturing Short Haul deliverymen Assembler machine operator fabricator deliverymen shipper receiver Technicians and Technologists Laboratory technologist draftsman occupation therapist speech therapist dental assistant Tradesman Group A Sheet metal worker pipe fitter millwright welder machinist assembler Tradesman Group B Plumber mechanic cabinetmaker electrician Sales and Service Field Technicians Hairdresser repairman baker cashier retail and stock clerk grocer surveyor assayer Senior executive management and professionals CFO president director doctor architect engineer office based pharmacist lawyer comptroller scientists primarily lab Occupation ACCOUNTANT Permanent Employment Ba 1 oct z006 Save Cancel ELT a toca intra Page 36 of 128 General Membership Details continued Cross References In some circumstances an employee may have two different identification numbers These numbers can be linked so the user can easily navigate between the two IDs The numbers must exist in the Cross Reference field for this to happen To enter or change this information click the radio button to the left of the Cross Reference title and then click the Update option from the navigation bar on the bottom of the screen The following screen will appear Enter the appropriate information and then click S
109. th Benefits 01Sep2003 26Aug2003 10 Drugs 01Sep2003 26Aug2003 Dental C DENTAL PACKAGE 1 Eff Dt Eff Trans Dt Term Dt Term Trans Dt Rating Status Family 6G Dental 01Sep2003 26Aug2003 Life e Loverage ALL EMPLOYEES CRITICAL CONDITION Applied For Eff Dt Eff Trans Dt Term Dt Term Trans Dt Rating Status Family C3 Critical Conditions 50 000 00 01May2005 23Apr2005 ALL EMPLOYEES OPTIONAL SPOUSE Coverage LIFE Applied For Ef Dt EffTrans Dt Term Dt Term Trans Dt 1 Optional Spouse Life 40 000 00 O1Sep2001 17Aug2001 ALL EMPLOYEES LIFE 1 Eff Dt Eff Trans Dt Term Dt Term Trans Dt 3 Basic Life 01Jun2000 29May2000 Disability ALL EMPLOYEES DISABILITY 1 Eff Dt Eff Trans Dt Term Dt Term Trans Dt 3 Short Term Disability 16Mar2000 30Mar2000 Add Coverage Amount Update Coverage Amount Add Package Revise Package Terminate Package Query javascript top uSubmit MemberSelectionInsuredsList memberSelectionsInsuredsListInquiry f fg Local intre Page 67 of 128 Member Selection Benefits continued Add Coverage Amount Optional Life Benefits Only continued Once the user has selected Add Coverage Amount from the previous screen the following is presented The user can enter a new amount and a new effective date Click Save to process the changes E ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross File Edit View Favorites Tools Help neh u not
110. the back of the application form please contact the call centre since specific information is required by Blue Cross to ensure claims are adjudicated properly Page 18 of 128 Member Add Insured Details continued Once the More Insureds button has been selected the following fields will be populated i ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross File Edit wiew Favorites Tools Help dh BLUE CROSS WELCOME PRIVACY E MAIL HELP LOGOUT Policies Members artic a Search insured Details Policy ID 12345 Division 000 COMPANY ABC Owner ABCC system ID 500293426 Main Division Atlantic Regional Group First Name Relationship Date of Birth JOHN Member 1 y Jan y 1970 Last Name Gender Privacy Consent SMITH Male Yes First Name Relationship Date of Birth Jane Spouse f Jan y 1972 Last Name Gender Privacy Consent Smith Female gt Yes Marital Status Date gt Day Month First Name Relationship Date of Birth Thomas Child 10 v Jan 2002 Last Name Dependent Status Gender Privacy Consent Smith Regular gt Male Yes Continue Cancel Delete Done ft fo fofe a Local intra Additional Insureds The information for the member is to be entered first If additional insureds are to be covered then click on the More Insureds button and enter the appropriate information Dependent Children When children are entered the status of the child
111. the top of the screen then the Membership Details tab Click the radio button to the left of the Employment Details title then click Update from the navigation bar on the bottom of the screen 2 Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross File Edit view Favorites Tools Help dh BLUE cross ae en a aT Policies Members Parties ee Search Member Selection Coverages Services Membership Details Member Activity Policy ID 12345 Division J000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293428 Membership Details Employment Details Occupation Category Senior executive management and professionals Occupation ACCOUNTANT Permanent Employment Date 010ct2006 Cross References Alternate ID 1 Alternate ID 2 Previous Membership Salary Information Hours Calculated salary Frequency per Week Eff Dt Eff Trans Dt Term Dt Term Trans Dt Annual Salary 65 000 00 Yearly 010ct2006 17 Nov2006 65 000 00 Add Update Query STD RQ ocal intra Page 35 of 128 General Membership Details continued Employment Details continued Select the appropriate Occupation Category from the drop down menu and enter a more detailed description in the space provided Selecting ALL from the dropdown will provide the user with an overview of all available categories ALL cannot be selected as an option The user is to
112. the user will be able to Add Update the Co ordination of benefits information Note Users with inquiry only access will only be able to view the above information 3 ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross File Edit view Favorites Tools Help dh BLUE CROSS WELCOME PRIVACY E MAIL HELP sour S Poticies Members parties SS M Search General Coverages Services Co ordination of Benefits Policy ID 12345 Division 0009 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293428 Co ordination of Benefits Last updated on 17Nov2006 Last Updated By MEDPA1 Effective Date of Coverage 01Feb2002 Termination Date of Coverage Other Insurer Carrier Name Policy Number 123 999 Identification Number 123987 Cardholder Name Jane Smith Cardholder Birthdate 01Jan1970 Type of Coverage ALL 3 HOSPITAL VISION DRUGS EXTENDED DENTAL Insureds All Update Query Dome Local intra Page 95 of 128 Member Selection Co ordination of Benefits continued Co ordination of Benefits To view the current Co ordination of Benefits information the user must go to the Member Selection Co ordination of Benefits tab To change the information click Update in the blue navigation bar on the bottom of the screen 3 ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross Fie Edit view Favorites
113. tions Employee Class AA Package MEDICAL PACKAGE 1 Rating Status Family Term Dt 30 Nov 2006 gt Coverage Applied For Eff Dt 4 Hospital 010ct2006 F Travel 010ct2006 1 Extended Health Benefits 010ct2006 5 Drugs 010ct2006 Save Cancel E Done p i mm z al Local intral Page 91 of 128 Member Selection Benefits continued Terminating Benefits continued When the information has been saved from the previous screen a warning box appears reconfirming the date that was entered Click OK if the information is correct Note The termination date cannot be more than 31 days in the past For terminations that are more than 31 days in the past please fax the request to the Customer Administration team at Blue Cross for manual processing 3 ABCC Enrollment Microsoft Internet Explorer provided by Medayie Blue Cross gt File Edit View Favorites Tools Help Ke dh BLUE CROSS WELCOME PRIVACY E g L HELP LOGOUT annii _ lt a Policies Members Products Partics Search General Coverages Services Insureds Benefits Co ordination of Benefits HSA Policy ID 12345 Division 0009 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293426 JOHN SMITH 500293428 Benefit Selections Employee Class AA Package MEDICAL Rating Status Family Term Dt 30 aif 9 The Package is being terminated as of 2006 11 30 Do you wish to proceed re
114. ttom of the screen From here the user will be presented with a series of screens to complete enrolment details Refer to the online User Guide under Member Enrolment for greater detail Active Active and Terminated Search by external identification number alternate identification number ih system identification number fe name Policy ID 12345 Dwisior Identification Number O00 Last Name Smith First Marne John Add Member Clear Search Fields Query Page 120 of 128 Changes to Existing Members Benefits and Personal Information To make any changes to an existing member s coverage or personal information the user must first open the member s file by using the Search function The user can search by identification number or name Once the search criteria are entered the user should click on Query from the blue navigation bar at the bottom of the screen They will be presented with a listing of all members matching the search information entered The user must then select the blue link to open the employee s file For more details on the types of searches that can be done refer to the online User Guide under Member Search a dhL IE CROSS WELCOME PRIV cy E MAIL HELP Loco a s i Member Search Active f Active and Terminated Search by external identification number alternate identification number system identification number name Policy ID Div
115. tus Family Status Eff Dt 01O0ct2006 Tag 00 Relationship Gender Date of Birth Term Dt First Name JOHN Member Male O1Jan1970 Last Name SMITH Tag 01 Relationship Gender Date of Birth Term Dt First Name JANE Spouse Female O1Jan1970 Last Name SMITH Tag 02 Relationship Gender Date of Birth Term Dt First Name JOHNNY Child Male O1Jun2005 Last Name SMITH Dependent Status Regular Relationship Gender Date of Birth First Name gt Day Month Last Name Dependent Status I Late Applicant Save Cancel Eje LY koanta Page 58 of 128 Member Selection Insureds continued Terminating a Participant with no Resulting Change to Status To terminate a participant s benefit coverage select Member Selection Insureds The following screen will be presented Click the box to the left of the participant to be terminated and then click Update from the blue navigation bar on the bottom of the screen E ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross Fie Edit View Favorites Tools Help O z le WELCOME PRIVACY MAIL HELP 4 onou dh BLUE CROSS eM i Policies Members Parties m M General Coverages Services FA Benefits co ordination of Benefits of Benefits Beneficiaries usa Policy ID 12345 Division 000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293426 Insured Li
116. tus title and then click Add Insured from the blue navigation bar on the bottom of the screen 3 ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross Fie Edit view Favorites Tools Help X 5 dh BLUE cross ee Ee a Poticies Members Partics Search General Coverages Services insureds Co ordination of Benefits HSA Policy ID 12345 Division J000 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293428 Insured List M Insured Status en Dt Eff Trans Date Term Dt Term Trans Dt Single 010ct2006 17 Nov2006 Tag Name Gender Date of Birth Age Eff Dt Term Dt E 00 JOHN SMITH Male O1Jan1970 36 01 0ct2006 Member Addinsured Update Query LL N Locate Page 52 of 128 Member Selection Insureds continued Changing to Family Status continued Once the Add Insured button has been selected from the previous screen the following screen will be presented Select the new status from the dropdown menu and enter the effective date of the change Enter the participant s information in the fields presented If additional participants are to be entered click the grey More Insureds button If dependents are to be late meaning that they are to be medically underwritten additional paperwork is required The user may select the Late Applicant button but without the paperwork the participant will not be underwritten If
117. wner ABCC system ID 500293428 Main Division Atlantic Regional Group Member Add Confirm The collection of the enrollment data for this member has been done Please select submit to approve the details Summary Show Details Submit Delete Local intra Page 21 of 128 Member Information and Changes Member Search Once the administrator has selected ES from the Application Menu they must click on the Members tab and then select the Search tab from the secondary navigation bar From here the Search screen will be presented To make any changes to an existing member s coverage or personal information the user must first open the member s file by using the Search function The user can search by identification number or name Once the search criteria are entered the user should click on Query from the blue navigation bar at the bottom of the screen They will be presented with a listing of all members matching the search information entered The user must then select the blue link to open the employee s file E ABCC Enrollment Microsoft Internet Explorer provided by Medavie Blue Cross File Edit wiew Favorites Tools Help Hf BLUE CROSS Policies Members Parties General Member Selection Coverages Member Search Active Active and Terminated Search by external identification number alternate identification number i system identification number Ry name Policy ID i2345
118. y numbers View changes that are pending to be processed that will affect the status or policy number Note Users with inquiry only access will only be able to view the above information gt ABCC Enrollment Microsoft Internet Explorer provided by Medayie Blue Cross File Edit View Favorites Tools Help dh BLUE CROSS Policies members Parties Search General Member Selection Coverages Request ID Activity Details Updates Policy ID 12345 Division 000 9 COMPANY ABC Owner ABCC H 7 Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293426 Activity Details Information on File Rating Empl Policy Div Status Prov Class Eff Dt Eff Trans Dt Non Life Term Dt Life Term Dt Series 12345000 Family NB A 010ct2006 17Nov2006 Retention Group Changes Requested None Query Delete Done BE BE al Local intr Page 112 of 128 Services Activity Details continued Activity Details Information on File This section of the screen summarizes the Rating Status Transfer Termination and Reinstatement history Changes Requested This section illustrates if there are any Rating Status Transfer Termination or Reinstatement changes pending to be processed All changes that are entered are not processed in real time the system updates overnight Monday through Friday In some instances more than one change is required to complete the requested change If the change in question
119. you sure you wish to submit this as is Coverage Applied 4 Hospital Cancel F Travel 1 Extended Health Benefits 010ct2006 5 Drugs 010ct2006 Save Cancel Opening page http liappstrn atl bluecross ca es Unifi Console uv3design es en members selections u_ uhtml RESULT_ID es en I o am al Local intr Page 92 of 128 Member Selection Benefits continued Benefits Summary To view a summarized version of changes to the benefit packages the user can click the grey Benefits Summary button at the bottom of the Benefits screen E ABCC Enrollment Microsoft Internet Explorer provided by Medavyie Blue Cross Fie Edit Yiew Favorites Tools Help dh BLUE CROSS WELCOME PRIVACY E MAIL HEL 1oGour Poticies e Parties e a Search Benefits Co ordination of Benefits HSA Policy ID 12345 Division O00 9 COMPANY ABC Owner ABCC Main Division Atlantic Regional Group Ext ID 500293428 JOHN SMITH 500293426 Rating Status Family 9 Dental 010ct2006 17 Nov2006 Life A amp ALLEMPLOYEES LIFE Eff Dt EffTrans Dt Term Dt Term Trans Dt 3 Basic Life 010ct2006 17 Nov2006 1 Accidental Death amp Dismemberment 010ct2006 17 Nov2006 c Coverage A ALLEMPLOYEES CRITICAL CONDITIONS Applied For Eff Dt Eff Trans Dt Term Dt Term Trans Dt Rating Status Family C3 Critical Conditions 010ct2006 17Nov2006 Disability A ALLEMPLOYEES DISABILITY Eff Dt EffTrans Dt Term Dt Term Trans Dt 3 Short Ter

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