Adding a Domestic Partner and/or Dependent
To add eligible dependents to an employee's coverage, follow the guidelines below. If the dependent is not added within these time frames, then in most cases, the dependent cannot be added until your next open enrollment period (and may be subject to pre-existing condition waiting periods).
A newborn dependent child (including a child adopted by the employee or placed with the employee for adoption within 31 days of birth)
31 days after the newborn’s birth, adoption, or placement for adoption
the appropriate premium payment (if sending with group bill)
On the date of birth
Other adopted children
31 days after the date the child was adopted by the employee or placed with the employee for adoption
proof that the adoption has occurred or is pending and the appropriate premium payment (if sending with group bill)
On the day the child is adopted by the employee or placed with the employee for adoption
Remember to notify us as quickly as possible of any adjustment, so we may keep your account as current as possible. In most cases, retroactive changes are limited and will not extend more than 60 days before the first of the month in which we receive them (See the “Retroactive Adjustments”
Open enrollment is the period of time during which your employees select their health care benefits for the upcoming year. Open enrollment should be held approximately one to two months before the desired effective date, typically the date your group renews its coverage with us.
However, there are other times when open enrollment for your group may occur:
| If you allow your employees to pay their health care premiums with pre-tax dollars under your "premium conversion" or cafeteria plan, you may also hold an open enrollment period prior to the beginning of the cafeteria plan year, if different from your renewal date. |
| An open enrollment period may also occur if, as an employer, you change your premium contribution off-renewal. For example, if you had been contributing 50% toward premium, and three months after you renewed you increased your contribution to 75%, you would be able to hold another open enrollment. |
If your group is not meeting group eligibilit
y guidelines for minimum employee participation that is discovered during an audit, BCBSGa/BCBSHP may grant your group a special enrollment period in order to increase participation.
Late Entrant Policy
Employees and their dependents who want to enroll for coverage under your group policy after your group's open enrollment is over can only do so:
| When they first become eligible for coverage; or |
| During a "special enrollment period" following certain specified events (described below). |
Those who elected not to enroll when they first became eligible and are not entitled to a special enrollment period are called "Late Entrants" and must wait until your company's next open enrollment period to enroll.
The “special enrollment period” is the 31 days immediately following one of these events, during which eligible persons may be enrolled:
| The employee’s marriage |
| The birth of the employee’s child |
| The employee’s adoption of a child, or a child’s placement with the employee for adoption |
| An eligible person’s loss of coverage under another health plan due to the employee’s divorce or legal separation |
| An eligible person’s loss of coverage under another health plan due to the death of the employee's spouse |
| An eligible person’s loss of coverage under another health plan due to a change in the employment status of the employee's spouse (including termination of employment or reduction in work hours) |
| An eligible person’s loss of coverage under another health plan (such as that of the employee's spouse) due to termination of the employer contribution |
| An eligible person’s exhaustion of COBRA coverage under another health plan |
| An eligible dependent's loss of eligibility for coverage under another plan; for example, due to attaining the limiting age |
| An eligible person's loss of eligibility for coverage under another plan because that plan no longer provides coverage to a particular class of persons |
| An eligible person's loss of coverage under another plan because the benefit option was discontinued when the insurance company ceased operating in the group market (unless coverage under another option is available to the individual) |
Enrollment other than during open enrollment period or a "special enrollment period" described above will also be allowed in certain other limited circumstances. These circumstances include:
| The issuance of a court order requiring an employee to provide health coverage for his or her non-custodial children. |
| Changes necessitated by the provisions of the cafeteria plan of the employee's domestic partner. Certain changes in coverage or cost of benefits provided under a cafeteria plan may permit election changes under that plan by the employee's domestic partner. We will accommodate these situations by allowing enrollment changes by the affected employee that are consistent with the change made by their domestic partner. For example, a domestic partner’s employer cafeteria plan may provide that elections may be changed if benefits for all participants are "significantly curtailed" or if there is a significant change in the amount participants must contribute. If the domestic partner changes his or her election for one of these reasons, we will allow the employee to make a corresponding enrollment change even if it is not your group's open enrollment period. |
If any of these circumstances applies to an employee's enrollment, attach a letter of explanation to the employee's application. If this documentation is not received, the application cannot be processed.
When enrollment information is sent to us more than 31 days after the requested effective date, the membership request is considered to be retroactive.
Two steps must be completed within the given time periods to enroll an employee on a retroactive basis and have the coverage be effective on the requested effective date:
| The employee must have completed and signed the application within 31 days of the date of eligibility. |
| The request for retroactive coverage must be received from the group within 31 days of the employee's date of eligibility. |
If you wait longer than 31 days from the employee’s date of eligibility to send in the request, we will consider processing the enrollment for open enrollment, but coverage will not be effective more than 60 days prior to the 1st of the month in which we receive your request. These guidelines apply to all insured groups. They also apply to self-funded groups and the shared risk HMO groups unless a previous exception has been made for your group.
Whenever possible, do not wait for your group bill before notifying us of any additions, changes or cancellations. Early notification reduces the need for retroactive adjustments and the likelihood that the change will not be made as of the requested effective date.
It is equally important that you let us know right away when an employee's eligibility ends. That employee's coverage should be cancelled, and should not continue to appear on the bill. If the employee (or covered dependents) enrolls in COBRA within the prescribed time frame, coverage will be reinstated retroactively.