Plan Eligibility Requirements – 31 is Key!

  • Employees that have met the plan eligibility requirements must be added within 31 days of their eligibility date
  • New spouses must be added within 31 days of date of marriage
  • New dependent babies must be added within 31 days of their date of birth or within 31 days of your legal guardianship
  • Common-law spouses and step-children that have completed the cohabitation period (as defined by your contract, usually 12 months) must be added within 31 days of their eligibility date
  • Employees and/or their eligible dependents that waived health and/or dental due to other coverage that lose their other coverage must add the applicable benefits on your plan within 31 days of the other coverage termination date.
Late applicants: Any of the above listed items that miss the required deadline will be considered late applicants and will be required to provide medical evidence of insurability and as a result may be declined coverage.  Furthermore, approved late applicants may have reduced dental limits for the 1st 12 months of coverage. In the event the carrier allows an exception full back premiums will be required.
TIP! Have your employees complete their benefit enrollment form at the same time as their other employment documents.  This will help to prevent late applicants and help the employee realize benefits are a condition of their employment.  Remember under enrollment negatively impacts all the plan participants and puts the employer and employee at risk!

 

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