Seeing a Doctor After Insurance Effective Date

Employees can still see a doctor or fill a prescription while waiting for a carrier to approve their insurance applications.

Remember:

  • Only eligible expenses can be reimbursed. Employees must review the Summary of Benefits and Coverage for the pending plan to understand which medical expenses are covered. Contact the carrier for more details on what types of expenses are covered under the plan before seeking care.
  • Expenses incurred before the employee's effective date are not reimbursable. Only expenses incurred on or after the employee's effective date will be processed by the carrier.
  • If the carrier does not approve the application, employees are responsible for the costs of care or prescriptions received while waiting for approval.

Office Visits

Employees can seek reimbursement for the cost of office visit to doctor or other care provider, or request an invoice for services.

  • Reimbursement: Pay for the visit out of pocket, then submit a reimbursement claim to the new carrier once the application is approved.
  • Request an Invoice: Some (but not all) providers will accept invoices from care providers once the insurance application is approved. Employees can request invoices from their care provider and submit the invoice after approval. Talk to the new carrier to determine whether this method is accepted.

Prescriptions

Employees can pay for covered prescriptions out of pocket and submit reimbursement claims for the cost of covered prescriptions once the application is approved. 

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