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Effective Dates & Probationary Periods
The effective date of a new employee and his or her eligible dependents depends on several factors:
The timeliness of the complete and accurate request
Your organization’s probationary period
The size of your group
The inpatient status of family members on the effective date (if a prospective enrollee is hospitalized, a previous carrier may be required to maintain coverage until the patient’s discharge)
Timeliness of Enrollment Request
We must receive a Group Enrollment Form for a new employee within 60 days of his or her eligibility date. Otherwise, the employee will not be able to enroll until your organization’s next open enrollment date. If you do not have a probationary period, an employee must submit a form within 60 days after his or her date of hire. It is important to inform employees of this rule.
You may find it best to have new employees complete paperwork immediately upon hire and send it in immediately, regardless of your probationary period. We will apply probationary periods in our membership files and begin coverage on the appropriate date.
Employees may initially choose not to take advantage of group coverage for themselves or their dependents immediately upon hire. If your group has open enrollment periods, please notify them that they will have to wait until an open enrollment period to enroll in the future. The only exceptions to these rules occur when employees or dependents meet special enrollment circumstances due to loss of coverage or family status changes. (See the Special Enrollments page for more information.)
A probationary period is the length of time your employees must wait before they are eligible for health benefits.
- Your organization determines whether or not to have a probationary period.
- If selected, your organiation sets the length of time employees must wait before gaining eligiblity. However, Blue Cross and Blue Shield of Vermont must administer it consistently.
The probationary period begins...
- On the employee’s date of hire, or
- On the day on which a part-time employee's status change makes him/her eligible for coverage.
Once probationary period ends, coverage begins...
- On the first day of the month after an employee completes the organization’s probationary period, or
- If the employee's probationary period ends on the first day of the month, coverage may begin on that day.
If there is no probationary period...
- Coverage can begin on the first day of the month after an employee’s date of hire.
- Employees who begin employment on the first day of the month may enroll immediately, provided they meet the guidelines in “Timeliness of Enrollment” above.
When employees leave employment and then return within six months—perhaps from a leave of absence or a lay-off—a new probationary period is often not required. These employees may enroll on the first day of the month after their return and must follow all other membership guidelines. If your group chooses, however, you may impose a rehire probationary period.
Transfers from Other Groups or Individual Coverage
When an employee joins your organization and is still covered by another membership, special rules apply. Regardless of whether the employee was covered by Blue Cross and Blue Shield coverage or by another insurer, he or she may not have to meet all or part of the waiting periods for pre-existing conditions under your plan.
When we take over a membership from another carrier who provided basically the same benefits as we do under your contract, we will credit the new employee with any time he or she accrued toward meeting waiting periods under prior coverage. If your BCBSVT contract has waiting periods equal to those of the prior coverage and the employee has met the old waiting periods, he or she does not have to meet waiting periods under our contract.
If an employee has met part of his or her waiting periods with the prior carrier, we will credit him or her with partially meeting our waiting periods.
For example, if Jane Doe has met four months of your prior carrier’s nine-month waiting period for pre-existing conditions, she must only meet another five months of our nine-month waiting period.
In order to administer credits for waiting periods, we may ask you for records from the new employee’s previous carrier.
Employees may drop their coverage at any time by completing a Group Enrollment Form.