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Enrollment Basics
Enrollment Opportunities
Employees may enroll in your group's plan during the following times:
- Initial opportunity - the first opportunity in which employee is eligible to enroll following completion of company's waiting period if applicable.
If employee refuses initial opportunity they cannot join until:
- Open enrollment - usually the anniversary date of the group's original enrollment
- Special enrollment - triggered by a qualified event
Enrollment Process
Determine Eligibility and Membership Type
Before enrolling each employee, you must determine
- His or her eligibility (eligible employees)
- His or her dependent's eligibility (eligible dependents)
- Type of membership employee will need
| Membership type | description |
|---|---|
| Single | Employee with no dependents |
| Two-Person | Employee plus one dependent (child, spouse, party to civil union, or eligible domestic partner) |
| Family | Employee with more than one eligible dependent. |
Note: Employees must enroll all eligible dependents with the exception of spouse, party to a civil union or eligible domestic partner; they may refuse coverage.
Complete a Group Enrollment Form
Enrolling employees: submit a completed Group Enrollment Form
Employees declining group coverage: submit a signed Group Enrollment Fom indicating refusal of coverage.
Note: Employees who refuse coverage cannot join the group until one of the two occurs: open enrollment or special enrollment
Primary Care Physician Choice (if Managed Care)
If a managed care plan is selected, a primary care physician (PCP) must be selected for the subscriber and all eligible dependents in order for membership to become effective.
Find a PCP (link to online provider directory)
