Late Enrollment
From WEA Trust Insurance Coordinators Handbook
Employees who waived coverage or who did not enroll when initially eligible may decide to enroll later. They may apply for coverage at any time by following the procedures below. We review the information and determine if the employee and/or their dependents meet our guidelines for enrollment. We will notify you and the employee in writing of our enrollment decision.
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Health plan
If an employee decides to apply for late enrollment to the health plan, he or she can use one of two options. The two options are:
Loss of other health coverage
To apply for enrollment, the employee must submit a Loss of Health Coverage form completed by the spouse’s former employer or insurance carrier and an Enrollment Form within 30 days of the loss of other coverage. Neither you nor the employee should assume that coverage is effective until we have notified you of the decision. If we approve enrollment, coverage will begin on the day following the date of loss.
If health coverage was initially waived because the employee or dependents had other qualifying coverage, it is possible to enroll if:
- The employee or spouse loses the other qualifying coverage; or
- The district’s contribution toward the employee’s insurance under this policy increases by at least 10% of the total premium in any 12-month period; or
- Employees who retire at age 55 or older and were previously eligible for coverage become eligible to enroll in the district’s group health plan upon retirement. Retirees wishing to obtain coverage must submit a completed Enrollment Form within 30 days after the official date of retirement (last day worked).
12-month waiting period
An employee who didn’t apply for the health plan within the 30-day time limit will be approved for health coverage upon completion of a 12-month waiting period. Coverage will be effective the first of the month following 12 months after we receive the Enrollment Form, provided the following criteria are met:
- The employee must be continuously employed by the district between the date of application and the end of the 12-month waiting period.
- The employee must belong to the eligible class of employees as specified by your district both on the date of application and on the effective date.
- The employee’s spouse and dependent children must meet the eligibility criteria both on the date of application and on the effective date if applying for family health coverage. There are two special enrollment circumstances when this 12-month waiting period may be waived:
- The employee has a loss of health coverage as explained above; or
- The employee acquires a newly eligible dependent through marriage, birth, adoption, or placement for adoption. If any of these events take place, coverage will be effective on the date of the event, as long as the employee completes and submits an Enrollment Form within 30 days of the event.
Dental plan
If an employee decides to apply for late enrollment in the dental plan, there are two methods of application available. If employees and/or dependents do not meet the criteria, they or their dependents will not be enrolled in the dental plan. The two methods of application are:
Loss of other dental coverage (involuntary event)
This requires proof that the employee and all family members applying for enrollment had coverage under another group dental plan and proof that the loss of coverage was due to an involuntary event, as defined below:
- A covered family member becomes ineligible for coverage under the other plan.
- The employee or his or her spouse is required to pay 100% of the cost of his or her employer-sponsored dental plan.
- The Trust group dental plan becomes noncontributory (100% paid by the employer) for the employee.
- A change in employee status (occupation, hours, etc.) that now requires the school district to pay 100% of the premium or increases the contribution to that of other full-time employees in the same eligible class.
If an involuntary loss of other coverage occurs, the employee must submit an Enrollment Form and a Dental Proof of Involuntary Loss form. The forms must be submitted within 30 days from the date of loss, or dental evidence of insurability will be required as described below. We will notify you and the employee of approval or denial.
Dental evidence of insurability
The employee may apply for coverage by submitting an Enrollment Form and a Dental Evidence of Insurability form for each person requesting coverage. For children age three and under, dental evidence of insurability is not required.
The dentist must complete each form using information based on results of a dental examination completed within four weeks from the date we receive the form.
We will notify you and the employee in writing of our enrollment decision. Neither you nor the employee should assume that coverage is effective until then. If we approve enrollment, coverage will begin on the first of the month following approval.
Note: If the employee is denied coverage, none of his or her dependents will be enrolled.
Long term disability (LTD) plan
90% benefit plan
Late enrollment is not an option for the LTD 90% benefit plan because this plan requires participation of all eligible employees.
67% benefit plans
An employee who didn’t apply for coverage under these plans may do
so at a later date by completing an Enrollment Form and the
Evidence of Insurability for Long Term Disability form.
Life
If the school district pays 100% of the premium, the plan requires 100% participation. A late applicant for life insurance completes the Group Life Insurance Evidence of Insurability form.
For LTD and life plans, the district should provide the employee with the appropriate Evidence of Insurability form along with an Enrollment Form. The employee must fill in all applicable information and mail both completed forms to us.
The information requested is confidential and should be submitted directly from the employee.
We’ll notify the employee and the district of our decision. If approved, the effective date of coverage is usually the first of the month following approval.
Long term care (LTC)
The group LTC insurance policy requires 100% participation. This means that all employees who are eligible for the group LTC plan must enroll.
Spouses must submit an Evidence of Insurability for Group Long Term Care form to be considered for coverage at any time after the employee’s enrollment. We’ll notify the spouse of our decision. If approved, coverage is effective the first of the month after approval.
Short term disability (STD) plan
An employee who did not enroll during the individual open enrollment period for this plan can apply at a later date. The employee must complete both:
- An Evidence of Insurability for Short Term Disability Plans form, and
- An Enrollment Form for Short Term Disability Plans.
We’ll notify you and the employee of our enrollment decision. If we approve enrollment, coverage will begin on the first of the month following approval.
