Looking for Forms? The links below give you instant access to a host of forms for many of your insurance needs. If you have any trouble finding the correct documents, please contact customer service for additional assistance.
Q: What address should my premium payments be mailed to?
If your 6 digit account number begins with a 1, 2, 4 or 6, please mail your premium payment to:
Kelsey National Corporation
P.O. Box 511365
Los Angeles, CA 90051-7920
If your 6 digit account number begins with a 3, 7, 8 or 9, please mail your premium payment to:
Kelsey National Corporation
P.O. Box 39220
Los Angeles, CA 90039-0220
Q: When are premium payments due?
Premiums statements are mailed on about the 5th of each month and due on the 15th prior to the month of coverage. Premium should be paid within 10 days of the due date. Our cut-off date for preparation of the next month's bill is around the 30th of each month (or prior working day if the 30th falls on a weekend or holiday). Unless we receive payment, additions, terminations or changes prior to that date, they won't appear on your statement until the second month following.
Q: What should I do if all insured persons in my firm are not listed on my premium statement?
If your bill does not list someone, please write us a note on the bill or attach a separate memo to the bill and forward with your payment. Please pay the amount shown on the bill. We'll adjust the next bill accordingly.
Q: What should I do if I think something on my premium statement is incorrect?
If you think your bill is incorrect, please write us a note on the bill or attach a separate memo to the bill and forward with your payment. Please pay the amount shown on the bill. We'll adjust the next bill accordingly.
Q: How do I enroll a new employee?
When hired, each individual must complete an Enrollment Form (and an evidence of insurability form when necessary) and submit it to our office immediately. For HMO Coverage, premium for the applicant should be submitted with the Enrollment form. Please contact your Account Executive in our Customer Service Department at (800) 366-5656 to get rates. Upon approval, your employee will be added to the next month's billing statement and billed accordingly.
Q: When does a new employee's coverage become effective?
Coverage for new employees is effective on the 1st day of the month following completion of the Waiting Period, (provided the enrollment material is received within the Waiting Period for all coverages selected).
Q: How does an employee add dependent family members for coverage or change from individual to family coverage?
When an employee wishes to add dependent family members for coverage or change from individual to family coverage, the employee should complete a new Enrollment Form. Please refer to your Certificate of Insurance to verify when additional dependents may be added.
Q: How does an employee add a new spouse for coverage?
The Enrollment Form should be sent to KNC within 31 days of the marriage date, in order for coverage to be effective as of the date of marriage. If you have HMO coverage, the new spouse's choice of Primary Care Physician must be indicated on the Enrollment Form. Be sure to indicate the date of marriage on the Enrollment Form. If the Enrollment Form is not received within 31 days of the marriage date penalties or limitations may apply. Call your Customer Service Representative for details.
Q: How does an employee add coverage for a newborn baby?
To provide continuous medical coverage for a new infant, the employee must complete and submit an Enrollment Form to KNC within 31 days after the birth of the child. Coverage for a newborn is not automatic. A newborn will be covered for the first 31 days from the date of birth if enrollment materials are received within 31 days. If enrollment materials are not received within 31 days, the newborn may not receive coverage. Call your Account Executive at (800) 366-5656 for details.
Q: How does an employee add coverage for an adopted child?
An employee's family coverage may be extended to legally adopted children. A new completed Enrollment Form and proof of adoption (copy of legal documentation) should be sent to KNC within 31 days of the adoption. No coverage will begin until all plan and enrollment requirements have been satisfied.
Q: How do I delete coverage for an employee who wishes to discontinue it?
To delete or discontinue coverage for an employee or their dependents, complete the Employee Data Change section at the bottom of your Premium Statement.
Q: How do I delete coverage for a terminated employee?
To report a terminated employee or their dependents, complete the Employee Data Change section at the bottom of your Premium Statement. Terminations must be reported within 30 days of the employee's termination date. Retroactive terminations are not accepted beyond 30 days. Please report terminations on the Premium Statement immediately following the change...or better yet, FAX this information as soon as it happens to your Account Executive at (310) 391-6534.
Q: When is termination effective?
Coverage shall terminate at midnight on the last day of the month in which the loss of eligibility occurs. A premium payment is due for the entire month.
Q: Is there a way for terminated employees to continue coverage?
When employment is terminated, the employee may be eligible for Medical or Dental coverage under COBRA if your firm has 20 or more full-time employees. Please refer to the section on COBRA Privilege in your Certificate of Insurance and your Administrative Guidelines or consult your Legal Advisor. Feel free to call your Account Executive for assistance. Also, terminated employees may be eligible to enroll in a Conversion Plan. For more information, please refer to the section on Conversion Privilege in your Certificate of Insurance.
Q: What should I do if a requested change does not appear on my billing statement?
Sometimes a change is received after the billing cut-off. If a change does not appear on your billing statement by the 2nd month, call your Account Executive in our Customer Service Department immediately at (800) 366-5656. Our aim is to provide the highest quality service by promptly responding to all requests we receive.
If your specific question and answer is not listed, simply complete the Kelsey National Q&A E-Mail Request. You will receive a prompt response from your Account Executive by phone or fax.
P: (800) 366.5656 toll-free
P: (310) 390.1000 local area
FAX: (310) 390.3158