Appeals and Administrative Error Letters - Not Needed

 Common Enrollment and Coverage Scenarios

Newborns Removed Due to Missing SSN

• If a child is removed from coverage because a Social Security Number (SSN) was not submitted within 90 days, no appeal is needed.
• The child cannot be re-enrolled until:
  • The next Annual Enrollment period, or
  • A Special Qualifying Event occurs

Pre-Paid Dental Cancellation Requests

• This is not an appealable issue.
• Agency Benefits Coordinators (ABCs) should submit a Prepaid Dental Cancel Request using the Insurance Cancel Request Form.
• Benefits Administration will:
  • Check for participating dentists within a 25-mile driving distance of the member’s home address beginning 1/1/2026.
  • If participating dentists are available and accepting new patients, the cancellation request will be denied

Employees Missing from Edison but Waived Coverage

• This is not an appealable issue.
• If an employee was never entered into Edison but intended to waive coverage, the ABC should:
  1. Hire the employee in Edison using a current or recent hire date
  2. Submit an updated Corrections and Clarifications (C&C) Form to Benefits Administration to correct the hire date
     (This applies only to employees who waived benefits.)