Enrollment
From WEA Trust Insurance Coordinators Handbook
Next section: Online Enrollment
When are employees eligible to enroll?
Employees are eligible to enroll when:
- They meet the eligibility criteria established by the district (and agreed to by the Trust) for participation in a group benefit plan; and
- They have satisfied the waiting period (if any).
If these two criteria are met, eligible employees can enroll in the following situations:
New employee
New employees have 30 calendar days from the date they’re first eligible to enroll.
Change in job classification
If employees become eligible because of a change in job classification, they have 30 days from the date of change to enroll.
Increase in hours worked
If employees become eligible because of an increase in hours of employment, they have 30 days from the date of such increase to enroll.
Change in job status/increase in hours
When an eligible employee has a change in job status or work hours which results in an increase of at least 10% in the amount of employer premium contribution (an increase equal to 10% of the single or family rate), the employee has 30 days to enroll. This applies to our health plan only. For dental eligibility, if the employee has a change in hours that results in premium contribution of 100%, or equal to a full-time employee, the employee has 30 days to enroll.
Marriage
An employee who marries can change from single to family coverage and add a spouse and new dependents if enrollment is completed within 30 days of the date of marriage. Coverage for the spouse and new dependents will be effective on the date of marriage. Dependents who were previously not covered may also be eligible for health coverage under a special enrollment period.
Return from leave of absence
If employees terminate their coverage while on leave, they have 30 days after returning to work to reenroll in coverage. Please see
Leave of Absence.
Enroll or change from single to family coverage due to birth of a child
An employee may request a change from single to family coverage due to birth of a child. The birth of a child creates an open enrollment for the employee as well as any eligible dependents. This applies to our health plan only.
Newborns
For health and dental coverage, a newborn’s coverage becomes effective on the date of birth, provided we are notified within 60 days. If we are notified after 60 days but within one year after the birth, the child can still be covered, but family premium plus interest as permitted by law is due from the date of birth.
If we are notified after one year from the date of birth, coverage may require acceptable evidence of insurability for dental insurance, and a 12-month waiting period may apply for health insurance.
Dependents who were previously not covered may also be eligible for health (not dental) coverage under a special enrollment period.
For life coverage, a newborn’s coverage becomes effective 14 days following the date of birth, provided the dependent is not disabled and we are notified within 30 days. If we are notified more than 30 days after the date of eligibility, coverage will require acceptable evidence of insurability for dependent life coverage. Family premium is due from the effective date of family coverage.
Adding dependents to existing family coverage
An employee with existing family health and dental coverage (not obtained through evidence of insurability) may add their spouse and/or dependent children after the initial effective date by submitting a written request. The coverage will be effective the first of the month, following the written request.
Loss of coverage
If employees waive the benefits of health or dental coverage because they have other group coverage, they may enroll in our plans if they lose the other coverage. This information is outlined in greater detail in Employee Status and Plan Changes.
