HMSA’s Group Leader Guide outlines the policies and procedures you’ll need to enroll, maintain, convert, and cancel members of your group.
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:
This coverage takes effect and your employees are eligible to receive benefits on their plan’s effective date as long as:
Your employees may enroll for coverage when they are first eligible, during open enrollment, or following a qualified event.
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.
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:
In general, your employees may enroll a child if the child meets all of these requirements:
In addition, your employee may enroll children who meet all of the criteria in one of these categories: