Trillium Community Health Plan

Revdex.com:I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to meSincerely, [redacted] ***

March 24, 2016
Revdex.com
ATTN:  Revdex.com Resolutions Consultant
1000 Station Drive, Ste. 222
DuPont, WA  98327
Complaint ID#:  [redacted]
To Revdex.com Resolutions Consultant:
This letter is in response to a consumer complaint filed against Trillium Community Health Plan...

(Trillium) regarding dental coverage that expired after member was informed he would be able to continue his coverage, according to the complaint information filed.
On 12/3/2015, a Trillium Customer Service Representative (CSR) contacted our member regarding his auto-pay being turned off for December. Member stated that beginning in January 2016, his employer was offering health insurance. He expressed that the dental insurance was expensive and wanted to remain with Trillium. Member was told he could pay his dental premium, and his plan would automatically roll over for January 2016.
On 2/4/2016, member called a Customer Service Representative (CSR) stating he was confused about his account and had just received a termination letter. Member had been insured with Trillium through Healthcare.gov on the dental exchange in 2015.
Member called HealthCare.gov in January to voluntarily withdraw his medical coverage. HealthCare.gov (per their guidelines) cancelled member’s medical and dental coverage. Member stated he was not informed that when he cancelled his medical insurance he would also lose his dental insurance.
Member was advised on 2/10 and again on 2/17 that he would need to go through HealthCare.gov to see if he qualified for a Special Enrollment Period (SEP) as Trillium could not activate coverage or accept premium payments due to the voluntary withdrawal through HealthCare.gov., and due to open enrollment being closed. Member stated he was directed by HealthCare.gov to contact Trillium.
A message was left for member on 2/25/2016 requesting a return call for follow up. On 3/18/2016, member was notified he would need to contact HealthCare.gov. Member again stated he has contacted HealthCare.gov trying to resolve this issue, and they referred him back to Trillium. It was explained to member that the SEP is determined by Healthcare.gov. The SEP includes time constraints, though a determination is based on the criteria involved. Member stated he was told he could still keep his dental insurance if he elected his employer’s health plan. It was then explained to member by CSR that all the information he received or did not receive can be reported as part of his communication to HealthCare.gov to file as a grievance for consideration of an SEP. CSR provided member with the phone number for HealthCare.gov.
We hope this information provides any clarification needed in order to assist member in resolving this complex situation. Please let us know if you need any further assistance.
Sincerely,
Grievances and Appeals Coordinator
Trillium Community Health Plan

We have contacted member for resolution.Tracie

Revdex.com:I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me. Sincerely, [redacted]