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Atlantis Health Plan Member Handbook- POS

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MEMBERSHIP ISSUES

There are two types of membership with Atlantis:

  • You are an employee or member of a Group who remits premium payments to Atlantis on your behalf; or,
  • You apply directly to Atlantis and make direct premium payments for your health insurance coverage. This contractual arrangement is referred to as an Individual Membership Contract or Direct-payment coverage.
Your Subscriber Contract provides details on eligibility and enrollment in the Plan. Please carefully review the terms and conditions of coverage. As a reminder, the following membership regulations apply:

Member Eligibility

To be eligible to enroll as a Group Member, you must be an employee or member of an organization having a Remittance Agreement with Atlantis Health Plan, meet the eligibility requirements of the Group, and reside, live or work in the Planís service area.

To be eligible to enroll as an Individual Membership Subscriber, you must meet the eligibility requirements under the Individual Contract, or meet the Individual Conversion Privileges guidelines, and live in the Planís service area.

Enrollment

  • Effective enrollment of the Subscriber and any dependents listed on the application form is subject to AHP acceptance of the Subscriber and his or her dependents.
  • All dependent children must be unmarried and within the age limits stated in the Subscriber Contract or any attached Rider.
  • Dependent children with developmental disabilities, or a physical handicap over the age of nineteen (19), who cannot support themselves due to their condition, may qualify for continued membership as a dependent. However, the condition must have been documented by a participating AHP primary care physician, and must have existed before the dependent reached the age of nineteen (19).
Enrollment Changes

It is important to notify AHP whenever there is a change in your family status.

AHP automatically covers newborn or newly adopted children for the first thirty- (31) days of their lives. However, in order to continue coverage with the Plan, you are required to complete an AHP "change in dependent status" form, pay any additional premium or contribution and submit it to AHP within the thirty-one days.

Should you get married and wish to change from single to family status, or convert a family Member who is no longer eligible as a dependent to his/her own coverage, please notify us.

Group members should submit notification of changes to your employer or remitting agent. If the form is not submitted in a timely fashion, you may have to wait until the next open enrollment period to add a child or spouse to the Plan or make other changes to your family status.

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