Health Insurance Special Enrollment Guidelines

Special enrollment

The only time employees or eligible family members are able to join or or cancel our health insurance is at the annual open enrollment period or with a qualifying event. Qualifying or triggering events are listed below. Notice period is 30 days except for Medicaid /SCHIP events.

 

Special Enrollment Triggering Event

Coverage Effective Date

 

Loss of Minimum Essential Coverage (does not include loss due to failure to pay premiums or rescission):

  • Loss of eligibility for employer-sponsored coverage
  • Termination of employment or reduction in hours
  • Legal separation or divorce
  • Loss of dependent child status
  • Death of employee
  • Employer bankruptcy
  • Employee becomes entitled to Medicare

Minimum Essential Coverage includes coverage under specified government sponsored plans (including Medicare and Medicaid), employer-sponsored coverage, individual market policies, grandfathered coverage, and other coverage recognized by the Secretary of the U.S. Department of Health and Human Services.

First day of the month following the event.

 

Gaining or becoming a dependent due to marriage.

First day of the month following the event.

 

Gaining a dependent due to birth, adoption or placement for adoption.

Date of birth, adoption or placement for adoption.

An individual gains or loses eligibility for Medicaid or MinnesotaCare (notice must be received within60 days of the event).

If application is received between the 1st and 15th of the month, coverage will be effective on the 1st of the following month.

If application is received between the 16th and the end of the month, coverage will be effective on the 1st of the following second month.

     

Note: This chart states the legal requirements. In some cases, we’ve been more generous and will not be changing our existing enrollment guidelines. Example: gaining or becoming a dependent due to marriage, in most cases coverage is effective the date of marriage.