03/31/2009
Individual Coverage – What agents can and can't do on behalf of a member
Agents can submit some applications on a member's behalf for Individual coverage, but there are a few things that only the member can submit themselves.
A member must call or write if they want to change their effective date; change their EFT information; cancel or add a newborn; or request a plan change. If your member forwards such information to you in an email, you can forward the email to wa–individual–sales@asuris.com. We will accept the email only if the information is clearly viewable.
To avoid confusion, we have created a chart that identifies what an agent is allowed to do on behalf of Individual and Medicare clients.
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Activity
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Agent
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Correct Spelling of Names
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Yes
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Correct Date of Birth
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Yes
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Correct Gender
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Yes
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Correct Social Security Number
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Yes
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Correct or Update Billing Address or Phone Number
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Yes
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Change Mailing Address or Phone Number
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Yes
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Cancel EFT
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Yes
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Change EFT Information
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No
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Request Reinstatement
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Yes
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Request an Appeal
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Yes – if the member signs a Disclosure Authorization allowing the agent to act on the member's behalf
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Request a Hold be Placed on Account
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Yes
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Change Effective Date
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No
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Change Billing Cycle
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Yes
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Request Corrections or Allocation of Payments
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Yes
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Change or Correct Member PCP
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Yes – as directed only for a minor child
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Request ID Cards
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Yes
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Obtain Information on Health Factor
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Yes
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Cancel an Application That Has Not Been Activated
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Yes
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Request a Copy of Health Questionnaire
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Yes
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Request a Copy of the Member's Application
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Yes
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Request to Add a Newborn
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No
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Receive Claim Information
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Yes – if in the capacity of our Business Associate
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Request HIPAA Cert to Other Covered Entity
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N/A – must be sent to other covered entity
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Add or Change a Broker
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Follow state rules for agent updates
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Cancel Anyone Other Than Themselves
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No – cannot cancel policy or dependents
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Request a Benefit Change
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No
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If you have questions, please talk to your Asuris Sales contact.
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