- Newborns Removed due to no SSN: An appeal is not needed if the child was removed due to not submitting the SSN within 60 days. The child will be removed and cannot be re-enrolled until either the following Annual Enrollment period or if the child experiences a special qualifying event.
- Pre-paid dental cancel requests: This is not an appealable issue. ABCs should submit request to cancel on the Insurance Cancel Request form. BA will verify if we have any participating dentists within a 25 mile radius of the member’s home address. If we do and they are accepting new patients, then the request to cancel will be denied.
- Employees Missing from Edison but with Waived Coverage: This is not an appealable issue. If the employee was never hired into Edison when they first became benefits elgiible but wanted waived coverage, the ABC can simply hire them. The ABC will use a current/recent hire date and then submit an updated C&C form to Benefits Administration to correct the hire date. This only applies to employees with waived benefits.
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