The Basics

This standard requires that your organization's communications plan explicitly provide that you inform consumers before you make changes in their covered benefits.  They must receive the notice before the change goes into effect.

An example of this would be in the event that he changed the copayments on one of your benefit plans.  You either need to send notice directly to the consumer, or have an assurance from the consumer's employer or the plan sponsor that it will give notice to the consumer in a timely manner.

Management Tips

This is one of those standards where it is not sufficient to do the right thing; rather, you must also have a policy and procedure that requires that you comply with the standard and describes how you will do it.

URAC Accreditation Tips

This single-element standard has a weight of 4.

For the desktop review, submit your formal communications plan, a summary listing of all benefit changes in the last two years (including the date of those changes), and sample correspondence to consumers regarding such changes.

During the on-site review, the reviewer will talk to customer service managers to confirm their understanding and implementation of your communications plan.