Active Provider Name Involuntary Project Provider Separation Code Code Provider Code Kaiser Permanente HMO 006 056 93003 COVA Care Basic 042 092 93002 COVA Care Out-of-Network 043 093 93002 COVA Care Expanded Dental 044 094 93002 COVA Care Out-of-Network and 045 095 93002 Expanded Dental COVA Care Vision, Hearing and 046 096 93002 Expanded Dental COVA Care Full 047 097 93002 COVA Care High Deductible 050 090 93005 TRICARE Voluntary Supplement 110 160 93038 COVA HealthAware Basic 101 151 93033 COVA HealthAware Expanded Dental 102 152 93033 and Vision COVA HealthAware Expanded Dental 103 153 93033 COVA Care High Deductible 105 155 93005 Expanded Dental Enter the membership type code. Status Membership Type Active/ LWOP S Single – O Single Part time – – F Family – M Family Part time – – D Employee plus one dependent – T Employee plus one dependent Part time – – W Employee waived coverage – Ineligible/Terminated E Employee not eligible for coverage – Leave Without Pay (LWOP) LWOP DHRM Policy requires employees on LWOP due to medical leave, agency Premium convenience, or layoffs to continue to pay the employee share. The agency must pay Payment the agency share of the healthcare premium. For other reasons (e.g., personal, education) the employee must pay the entire healthcare premium.
Provider Name Active Provider Code Involuntary Separation Provider Code Project Code Kaiser Permanente HMO 006 056 93003 COVA Care Basic 042 092 93002 COVA Care Out-of-Network 043 093 93002 COVA Care Expanded Dental 044 094 93002 COVA Care Out-of-Network and Expanded Dental 045 095 93002 COVA Care Vision, Hearing and Expanded Dental 046 096 93002 COVA Care Full 047 097 93002 COVA Care High Deductible 050 090 93005 TRICARE Voluntary Supplement 110 160 93038 COVA HealthAware Basic 101 151 93033 COVA HealthAware Expanded Dental and Vision 102 152 93033 COVA HealthAware Expanded Dental 103 153 93033 COVA Care High Deductible Expanded Dental 105 155 93005 Enter the membership type code. Status Membership Type Active/ LWOP S – Single O – Single – Part time F – Family M – Family – Part time D – Employee plus one dependent T – Employee plus one dependent – Part time W – Employee waived coverage Ineligible/Terminated E – Employee not eligible for coverage Leave Without Pay (LWOP) LWOP Premium Payment DHRM Policy requires employees on LWOP due to medical leave, agency convenience, or layoffs to continue to pay the employee share. The agency must pay the agency share of the healthcare premium. For other reasons (e.g., personal, education) the employee must pay the entire healthcare premium.
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