| |
Small Group Health Plan Enrollment Guidelines |
Typically, Blue Cross Small Group Health plans have specific eligibility guidelines. It is strongly recommended that you yourself understand these guidelines, so that when the time comes to explain to your employees what they will need, you will be up to speed.
Blue Cross has a variety of guidelines, depending on your status or that of an employee, to determine eligibility with a group health plan. Here are just a few of the general enrollment guidelines that you can expect, but each plan may have different requirements:
Eligibility for Employees
Full-time employees will be considered eligible if you employ them on a permanent basis and they put in at least thirty hours per week. They can’t be volunteers, and you must pay them for the work they do.
Part-time employees must, again, be in your employ on a permanent basis and put in at least a twenty-hour week. Again, you must pay them for their work. To maintain this status, they cannot work more than twenty-nine hour weeks. You aren’t required to offer any health insurance to part-time employees, but if you want to, Blue Cross offers it, and they must stick to this eligibility framework.
If you are sole proprietor, a partner or a corporate officer, you must work for your company at least twenty hours a week to be considered eligible for your group health plan with Blue Cross.
Employees who aren’t eligible are seasonal (holiday seasons, for example), substitute, or temporary in another way, or employees who are paid on a 1099 basis, such as freelancers or independent contractors.
Eligibility for Dependents
Under your Blue Cross group health plan, employees’ dependents are eligible for coverage if they are:
a lawful spouse
an unmarried child under the age of 19
an unmarried child between 19-24 who is a full-time student.
Legally adopted children of employees or their spouses qualify as dependent children. In some instances, domestic partners may also qualify as dependents, but there may be restrictions. You’ll need to ask your Blue Cross provider for more details.
Employer Waiting Periods
The length of the waiting period for new employees is your choice; you can choose as soon as one month or as long as six months before they become eligible for coverage with your Blue Cross group plan.
Effective Dates
With Blue Cross, the group policies go into effect on the first or the fifteenth of the month. If you purchase a policy between these dates, the coverage won’t kick in until the first or the fifteenth arrives – whichever comes first.
Preexisting Conditions
The Blue Cross parameters for a preexisting condition are defined as a medical condition for which an employee received medical care, treatment, was diagnosed or advice six months before the effective date of coverage. There are exceptions to this time period - you will need to check with your representative for more information.
It is important to thoroughly review this information before signing any policy, to ensure that you are completely aware of any and all restrictions or guidelines
Late Enrollment
It’s important to educate your employees on the advantages of joining at the same time as the rest of the group: if they or their dependents who are eligible for coverage decide to wait, they will be forced to adhere to a twelve month waiting period should they change their mind and join the group policy later on.
Learn more at: www.baahealth.com
|
