What to Expect after you Enroll?

After You Enroll

Now that you’ve enrolled, it’s only a short time before you may begin using your new Optimum Benefits.

The General Process

Once you submit your enrollment (online or through an agent), it goes through the following steps:

Step 1.

If you complete an Application with an Agent licensed by the State and contracted with Optimum HeathCare, your Agent forwards us the Application via overnight delivery. (If you complete your Application online, it automatically proceeds to Step 2.)

Step 2.

Once we receive your Application, our Application Support Team does a preliminary review for any missing information.  If we need additional information, we will contact you or your Agent.  If the Application is complete, it is forwarded to our Enrollment Department.

Step 3.

Within 24-48 hours of receiving the completed Application, our Enrollment Department puts the application information into our database and sends it to the Centers for Medicare and Medicaid Services (CMS), the federal agency that oversee Medicare. Your new membership is relayed to our fulfillment vendor who puts together a Welcome Packet (with an Acknowledgement Letter and ID Card) for you. You should receive this within 7 days from the date the plan receives your enrollment.

Step 4.

Usually within 2-3 days of receipt, CMS reviews the data on the Application, and either approves the Application or rejects it.

Step 5a.

If the Application is approved, you become a member of Optimum HealthCare on an Effective Date of Coverage as determined by CMS at which point Optimum HealthCare will send you a Confirmation Acceptance Letter.

Step 5b.

If the Application is rejected by CMS for missing or incorrect information, you will receive a letter requesting the required information and the Optimum HealthCare Enrollment Department will work with you to resubmit a corrected application to CMS. However, if your Application is rejected due to reasons beyond our control, you will receive a denial letter indicating the reason for rejection. In this case, you are not considered a Optimum HealthCare Member.

We hope this clarifies the enrollment process for you. And remember, by enrolling online, you can reduce the application processing time.

Still Need Help?

Member services or one of our local Concierge Offices can help you if

  • You didn’t receive an Enrollment Kit with your Evidence of Coverage, a Provider Directory, and Abridged Formulary
  • You didn’t receive (or lost) your Member ID Card
  • You have a questions about your Benefits

Click here to Enroll

Last Updated: 10/01/2016