Employees can make changes to their insurance plan during the plan’s annual open enrollment and, in some cases, outside of the open enrollment period. Here are the guidelines that you should keep in mind when managing enrollments:
Eligible employees. To be eligible for coverage, employees must work full time for at least 30 hours per week and be paid by W-2.
New enrollments. Completed member enrollment applications for new enrollees (new hires or current employees with a qualifying event) must be received within 30 days of the requested effective date.
Enrollment changes (addition or deletion of members). There may be changes in a member’s life that require changes to enrollment, such as marriage, birth, divorce, Medicare eligibility, Medicaid eligibility, adoption, etc. All requested changes must be received within 30 days of the qualifying event. After 30 days, the application may be resubmitted during the annual/open enrollment period.
Annual open enrollment. The completed employee application or employee change form must be received within 30 days of the annual open enrollment month, to be effective on the first day of the anniversary month.
Special Enrollments for Qualifying Events
If someone was previously eligible for coverage wants to apply following initial enrollment, he or she may be allowed to enroll during a special enrollment period. The following must be met:
- The employee or dependent declined coverage initially due to other health coverage ending:
- He or she was under COBRA coverage and that coverage has ended.
- Other such coverage ended because of a loss of eligibility or an employer’s change in contribution towards such coverage.
- The individual became a dependent of a certificate holder through marriage, birth, adoption or placement for adoption.
For questions, please contact your ARC Benefit Solutions Client Relations Advisor. We appreciate the opportunity to help you!