/  Administrative Resources

Administrative Resources

Group Leader Guide

HMSA’s Group Leader Guide outlines the policies and procedures you’ll need to enroll, maintain, convert, and cancel members of your group.

Other Resources for Your Employees

In addition to the information in the Group Leader Guide, you may find helpful some of the information we offer to our members. This includes:

Additional Information on Eligibility

Coverage activation

This coverage takes effect and your employees are eligible to receive benefits on their plan’s effective date as long as:

  • Initial dues were paid; and
  • HMSA accepted your employee’s employer enrollment form and gave your employee written notice of their effective date. By submitting the enrollment form, your employee also accepts and agrees to the provisions of our constitution and bylaws now in force and as amended in the future; and
  • Your employee’s eligibility for coverage is subject to all applicable waiting periods.

Your employees may enroll for coverage when they are first eligible, during open enrollment, or following a qualified event.

First eligible

Your employees may enroll when they’re first eligible according to your group sponsor’s rules for eligibility. If they don’t enroll when they’re first eligible or by the first day of the month immediately following the first four consecutive weeks of their employment, they won’t be able to enroll until the next open enrollment. However, if they show us to our satisfaction that there was unusual and justifiable cause, they may have the opportunity to enroll sooner.

Annual enrollment

Your employees may enroll during open enrollment by naming themselves and their spouse and/or child(ren) on the enrollment form. If they don’t sign up during open enrollment, they won’t have another opportunity until the next open enrollment the following year. We can make an exception if they have an unusual and justifiable cause. In such cases, they may be eligible to enroll sooner.

Qualifying events (birth, adoption, marriage)

Your employees may enroll for coverage within 31 days of a qualifying event. If they don’t enroll within 31 days of the event, the next enrollment opportunity is during the following year’s open enrollment. These are examples of qualifying events:

  • Birth.
  • Adoption. In cases of adoption, we must receive notice of the event within 31 days of adoption placement (the date they assume a legal obligation for total or partial support of the child in anticipation of adoption).
  • Marriage.
  • Loss of coverage by their spouse under another plan.

In general, your employees may enroll a child if the child meets all of these requirements:

  • The child is under 26 years of age; and
  • The child is their son, daughter, stepson or stepdaughter, their legally adopted child or a child placed with them for adoption, a child for whom they are the court-appointed guardian, or an eligible foster child (defined as an individual who is placed with your employee by an authorized placement agency or by judgment, decree, or other court order).

In addition, your employee may enroll children who meet all of the criteria in one of these categories:

  • Children with special needs.
  • Children who are newborns or adopted.