Date calculations
When calculating a termination date, the date you entered in the system is the date that they were terminated?
True or false
False. You are to enter the date that you received the notification
True or False
First-time users are prompted to register with their own Social Security number
True
A dummy Social Security number is created when the inquirer does not have or wish to use their own Social Security number.
What is Access to Care
Access to care (ATC) issues exist when a member needs immediate pharmacy, medical, or dental services and requires Humana to provide verification of eligibility and/or benefits to a provider or member
What mentor documents can be used to assist with termination of a member?
Termination of Member Call
Where do we locate the count for the group?
Answer:
List Group>group>Group miscellaneous maintenance
Natalia was with the Sagility on 04/01/2025, However, she came back to the company on 05/01/2025. What would her eligibility date be?
She would be reinstated with no Lapse in coverage
If an employee is going from one division to another division, what option would you advise the caller to use in HRBA?
Answer: Change in eligibility group
How long does an IMS Ticket takes to be resolved?
24 hours
Does EDI groups submit file feed to humana for termination, or can you process the termination in HRBA?
Answer: If the group is EDI, they would submit termination notice via File FEED
CI
Where do we locate pend information?
Answer EPER screen
Terine was let go from the company Gregg’s Wheel and Alignment (Group #698876) on 10/20/2024. However she was decided to come back to the company cause money affi mek. She was rehired on 10/30/2025. What would be her Eligibility date?
Answer: 01/01/2026
True or Fase
We can terminate an employee beyond 60 days in HRBA?
False
HRBA does not allow termination to be done beyond 60 days. Termination request Beyond 6o days can be submitted as an exception
ATC reason: Existing member needs benefits, what is the Criteria Catalog number?
Answer: 5134
The member has a PPO dental policy, and the policy was issued in Texas, Does the State mandate termination applies?
Answer; No it does not apply it only applies to DMH dental policies.
What does EMP means in "GA EMP 19 TRP100/90/60,D50,AM9999999,ENDO BASIC 1+,PERIO BASIC 1+"?
Answer: Employee Sponsored
If you are to do a termination in HRBA and you are trying to determine a termination date of an employee who was with the company on 01/01/2026, What information do you put in the calculator?
Answer: The date the humana was notified via phone
60 days
Change adds to subtract
Danae left the Company Devon house on 01/01/2026, her Coverage was supposed to start on 02/01/2026. What's the next step you would take to terminate her in HRBA?
She should be voided from the system.
Coverage termination date is 01/01/2026 and the sign date is whenever you received the Call
ATC Reason: New member (not currently in systems) needs benefits. What is the Criteria Catalog # and the Issue Criteria Name ?
Answer: Criteria Catalog #5118
Issue Criteria name: Enrollment | Work Request | New Enrollment | Benefits not loaded/not on platform
Tremayne Left the Company on 04/20/2025, The Employer is now calling on 08/01/2025 to have Tremayne terminated in the system. What would his termination date be if given an exception to go beyond the 60 days?
The group provision is first of the month following
Answer: April 30, 2025
Credit for prior coverage can be applied to a member waiting period. What timeframe would a member be eligible to add prior Coverage to current coverage
Answer: 63 days or less
63 days and over, the credit cannot be applied
A Colorado group member leaves the employer on 8/14. The employer informs Humana on 8/27 of the termination. What is the member’s term date if the group has an immediate provision?
Answer: 08/14
True or false
HRBA provides the timeframe for changes to become effective in system once submitted?
True
HRBA will always provide with an excepted timeframe once an application/Termination is submitted online
What mentor Doc do we use to identify ATC issues?
Answer: Access to Care Issue Identification
What is the mentor Document that assist in determine the termination date for an employee of Texas?
Answer :Terminations and SB 51 for Texas
What is e verification?
A system that takes a screenshot/snip of an application/termination that was submitted in HRBA