Welcome to Dean Health Plan! We are looking forward to working with you and your employees. We are here to serve your needs not only as a member of Dean Health Plan, but as the plan administrator, the person your employees will look to for answers.
Below are some of our most commonly asked questions and essential information to help you.
DeanConnect for Plan Administrators
As the plan administrator for your company, you will use DeanConnect
differently than you will as a member of Dean Health Plan. As the plan administrator you will login to DeanConnect
to accomplish tasks such as:
• Adding a new employee to the plan;
• Terminating an ineligible employee from the plan;
• Adding a new dependent;
• Updating demographics;
• Checking enrollment status
You must request a Plan Administrator Login to DeanConnect from your Associate Account Manager.
Please Note: As a member of Dean Health Plan you will have a different login to manage your personal insurance coverage.
Prior Authorization FAQs
What is a prior authorization (PA) request?
A PA request is an extra step that is sometimes required before a member receives a specific service or procedure. A PA will not allow a service that is non-covered or a specific exclusion under the Member Certificate. For example, if cosmetic surgery is an exclusion of the policy, a PA will not change that benefit.
When and why is a PA needed?
Members can go to deancare.com/member-benefits or log into DeanConnect to view their member certificate or contact the Dean Health Plan (DHP) Customer Care Center to determine if the service or procedure requires a PA. For HMO members, typically anything out of plan requires PA.
Some specific services require PA so that Medical Affairs can review the medical necessity of these services. Seeking services with non-plan providers/out-of-network will usually require PA.
How does a member obtain a PA?
A member must obtain a written authorization letter from DHP approving the requested service or procedure to give to their provider. It is the member’s responsibility to secure written authorization approval before receiving treatment to ensure proper handling of the claim.
My employee obtained a PA, why are they still being charged for the service?
Obtaining a PA does not mean that services will be covered at 100 percent; members are still responsible for normal copays/deductibles/coinsurance amounts for any authorized services.
When is a PA considered urgent?
Authorization requests are not considered urgent only because of scheduling needs, they must be medically urgent to be processed more quickly than the standard 14-day or less timeframe.
I received a clinical referral. Do I still need to process a PA with Dean Health Plan?
Yes. A clinical referral is different than an insurance authorization or referral. For example, an ENT doctor might require a referral from a family practice doctor to ensure patients are coming to them appropriately. If the ENT doctor is out-of-network, having a clinical referral to a specialist is not equivalent to an insurance authorization to receive those services.
What will my Bill look like?
The cover sheet will provide summary information including invoice date and billing period, a line item total of each of the group segments and grand total.
Following the cover sheet, you will find all group segment pages with detail listing each subscriber, tier and monthly premium amount.
Following the billing detail, you will find the deletions worksheet where any terminations can be noted.
You have a grace period of 31 days from the due date of the bill to make the premium payment. Your group coverage will remain in effect during the grace period. You will receive a late payment notice from us, this is a standard notice mailed when premium payment is not made. The premium payment must be received by the end of the grace period or cancellation will occur.
Payment of your Premium Invoice
DHP offers you two options when paying your premium invoice.
- Payment by check upon receipt of your premium invoice which includes a reply envelope.
- Automatic Withdrawal (ACH) from your group's bank account.
When can I expect my first Dean Health Plan invoice?
You will receive your first Monthly Premium Billing Invoice on or around the 20th of the month of your group’s effective date.
What is included in the first invoice?
This invoice will represent premium for your group’s first two months on the plan, and it will include a discrepancy report to reconcile your initial binder payment.
What happens if I make changes to my plan after submitting my binder payment?
Please note that any membership adjustments received on or after the 15th of the initial month of your coverage will not be reflected on your first Monthly Premium Billing Invoice. These changes will be reconciled on the next month’s invoice.
What is the billing cycle after the first month’s invoice?
Regular monthly Premium Billing Invoices are prepared approximately 45 days in advance of their due date and are mailed on the 10th of the month prior to the due date. For example, invoices for October Premium are prepared at the end of August, mailed on September 10th, and due on September 30th.
Who can I contact with questions about billing?
For questions about your Premium Billing Invoice, please contact Dean Health Plan’s Enrollment & Billing Department at (800)649-0258.