1-50: Important Updates to the 2014 Admin Manual

Late enrollment

First of the month following receipt of application provided there is not a waiver on file

No longer accepted. Must wait until group’s next Open Enrollment/Anniversary month 

Waiting period

Up to 6 months

Either first of the month following date of hire (DOH), or first of the month following 30 days, not to exceed 60 days¹

Newborn baby 

• First of the month following date of birth (DOB)
• Can be enrolled over the phone
• 30 days to submit application

• Effective date is DOB
• Cannot enroll over the phone – must submit application
• 60 days to submit application

New spouse/domestic partner

• First of the month following event
• 30 days to submit application

• Effective date is date of event
• 60 days to submit application

Age determination (billing)

First of the month following age change

Age change not calculated until group’s next Open Enrollment/Anniversary Month.  Note: Age for new hires is based off their age when they enroll, not at what their age would have been at the group’s original effective date or anniversary. 

Qualifying event

60 days

Newly eligible employees

ACA phone and fax number

No primary or secondary Medicare rate              

Incomplete documents

First of the month following receipt of completed application                                                                                                                                               

Terminations

First of the month of request received

First of the month of request received² (Exception: In the case of the death of a single subscriber, benefits will now be terminated the day after death)

Retro activity

None

None