Home Web to case - Form Request Testv2 Web to case - Form Request Testv2 Contact Name Email Phone Subject Description Company Type--None--AppealComplaintQuestion Status--None--NewLive InteractionWorkingClosed Case Reason--None--AbandonAppealBenefitsCarrier DiscrepancyDemographic ChangeDEVAEligibility or EnrollmentFeedbackGeneral InformationNot IndicatedOpen EnrollmentPayments-Refunds-DeductionRetireeSelf ServiceYear End Priority--None--HighMediumLow Quick Case Comment: Resolution Detail:--None--Payment/Refund ProcessedRetirement ConsultationBenefits Enrollment UpdatedNot EligibleRequested Materials SentBenefits Information ProvidedReferred Member to 3rd PartyDemographic\Contact Information Updated Sub Reason:--None--1095Abandoned CallAbandoned Drop InAdoption & Surrogacy AssistanceAppeal - 1st LevelAppeal - 2nd LevelAppeal - HSBAuto PayBenefit PremiumBlue Shield Access+Blue Shield - TRIOBSC PPO - AccoladeCarrier Discrepancy - DemographicCarrier Discrepancy - EligibilityCarrier Discrepancy - Premium ReconciliationCity Health PlanCourt Order/QuashDelinquency or Payment/RefundDeltaCare DMODelta Dental PPODemographic Change - DependentDemographic Change - MemberDEVADEVA - DocumentationDEVA - GeneralDEVA - Self-ServiceEligibility - Dependents - Disabled ChildEligibility - Dependents - GeneralEligibility - MedicareEligibility - MembersEnrollment - COBRAEnrollment - ConfirmationFeedback - ComplaintFeedback - Non-complaintGeneral - Hours or LocationHealth Net CanopyCareHire - CCDHire - CCSFHire - MEAHire - SFUSDKaiser HMOKaiser Senior AdvantageNo showOpen Enrollment - Confirmation LetterOpen Enrollment - GeneralOpen Enrollment - Initial MailingP&Apay.sfgov.org infoReopen OE EventRetiree - CounselRetiree - EnrollRetiree - MedicareSelf Service - EnrollmentSelf Service - GeneralStatus Change - Family/JobThe Hartford (Life-Disability)United Healthcare Dr. Plan EPOUnited Healthcare non-MedicareUnited Healthcare Select EPOUnited Healthcare COBUnited Healthcare DMOUnited Healthcare MAPD NPPOVision Service PlanVoluntary Benefits Case Age In Business Hours: Last Status Change: Time With Customer: Time With Support: Entered Name: Case Start: Case Description Summary: Start of First Level Appeal: Start of Second Level Appeal: Start of Board Level Appeal: First Appeal Response: Second Level Appeal Response: Board Level Appeal Response: Start Date of Appeal: Level of Appeal:--None--First Level AppealSecond Level AppealBoard Level Appeal Date of Appeal Response: Temp Action Field: Escalate to:--None--Supervisors Time Escalated: Case Picked Up: End of Face-2-Face Time: Last Opened: Counting: 65 minutes after Case Creation: Benefit Status:--None--Actively Employed / Prospective City WorkerRetiree / Intend to Retire in next 90 days Benefit Status: status_phone:--None--ClosedWorking phone_case_flow_tf: Visit Nature: Visit Nature:--None--2018 Health Benefits2019 Open Enrollment Health Benefits Delinquent Status Change: Send Alert:--None--Delinquent Status ChangeESA HelpNotify ManagementOE Follow Up Send Alert Phone Flow:--None----None--Delinquent Status ChangeESA HelpNotify Management On Website: Improper Escalation: