QUEST Integration - Plan Changes

Original Effective Date:

08/01/1994

Current Effective Date:

01/01/2015

Members may change QUEST Integration plans during the annual plan change period.  Changes at other times are done only under very limited circumstances by the DHS.  For instances not identified for approval by DHS, plans may agree to member changes outside of the annual plan change period and must be approved by the affected plans.  This is called plan to plan change.  Each plan makes its own policies regarding plan to plan changes outside the normal plan change period.  It is a voluntary process between the plans and is not a DHS requirement.  Plan decisions may not be appealed and plans need not give reasons for their decisions related to plan changes.

For plan to plan changes, if a member believes that his/her circumstance is unusual and  not covered by the DHS allowable changes, the member must initiate a transfer with the plan he/she currently is enrolled in. The plan must agree to release the member, and the new plan must agree to accept the member and his/her family.

HMSA generally does not approve plan transfers outside the annual plan change period for members who are trying to:

• Access specialty care, or
• Rejoin HMSA after leaving voluntarily during the annual plan change period.

A transfer to another plan, PCP, or provider can be made immediately if a member's health or safety is in jeopardy.

Revision History