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New Enrollment
Enrolling an Employee in Group Coverage
An eligible employee may enroll in group coverage during these times:
- Initial enrollment opportunity - first opportunity in which employee is eligible to enroll following completion of company's probationary 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.
Some small groups do not have open enrollments because of State laws forbidding them. Members of these groups may add eligible members at any time, provided they have met any company probationary period.
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 eligible 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 following exception: a spouse, party to a civil union or eligible domestic partner who may refuse coverage.
Give Employee a Summary of Benefits and Coverage
Federal law requires that employers must provide all their employees with a copy of the Summary of Benefits and Coverage (SBC) with an application for insurance. Prior to completing an enrollment form, you must ensure that your employees have the SBC or SBCs that apply to the coverage for which they may enroll.
Complete a Group Enrollment Form
Enrolling employees: submit a completed group enrollment form.
Employees declining group coverage: submit a signed group enrollment form indicating refusal of coverage.
Note: Employees who refuse coverage cannot join the group until one of two things occurs: open enrollment or qualifiying event.
Primary Care Physician Choice (if Managed Care)
If a managed care plan is selected, a primary care physician must be selected for the subscriber and all eligible dependents in order for membership to become effective.
