HMO Transfer Program Change

In 2001, UC implemented a pilot program that later became a permanent policy called the Health Maintenance Organization (HMO) Transfer Program. This program allowed employees to switch between the California-based HMO medical plans mid-year, or outside of the November Open Enrollment period.

Since the beginning of the program, the University was able to apply a more liberal application of the rules by allowing mid-year transfers for "any" reason rather than just for provider group disruptions. However, as the number of mid-year HMO transfers has increased substantially, concerns about adverse selection and administrative overhead for the plans have resulted in a need to return to the original intent of this program.

Effective immediately, employees will only be able to use the HMO Transfer Program when there is a demonstrable provider group disruption. A provider group disruption is when an entire medical group(s) cancels its contract with an HMO (one physician dropping out of a plan does not qualify as a provider group disruption).

Prior to processing an HMO Transfer request, Campus or Healthcare Benefit Services will require documentation of the provider group’s withdrawal from Health Net, PacifiCare or Kaiser in order to allow transfers into another California HMO plan including Health Net, PacifiCare, and Kaiser. While Kaiser is included here, it is highly unlikely that a provider disruption would occur in the Kaiser plan. The annual Open Enrollment Period is still available for employees to transfer to any medical plan available to them for any reason.

A new EDB Code, DR, has been created for HMO Provider Disruptions. Campus and Healthcare Benefit Services will only use this new code, and only they can process mid-year changes under the Transfer Program. The department EDB Preparers do not have authority to process these transactions.

Employees who wish to transfer plans under this program would complete a UPAY 850 and submit it to the person in their department who handles benefits for forwarding to Campus or Healthcare Benefit Services for processing. 
 

Campus Human Resources, Benefits Services
Phone: (310) 794-0830 | Fax: (310) 794-0835