Reminders for group benefits plan administratorsSubmitted by Brian Shaw, CHS | Brenda Shaw, CHS on February 26th, 2018
What is a late applicant?
Group insurance carriers require that employees and their dependents enrol for group benefits within 31 days of becoming eligible (usually three or six months after being hired). A good way to avoid having late applicants is to have new employees complete their enrolment forms when first hired.
What happens if an employee does not enrol within the required enrolment period?
The employee can still enrol for the group benefit plan, but the insurance carrier will treat him or her as a “late applicant.” This means the employee and their family members will have to fill out a medical questionnaire to prove they're in good health.
Late applicants who are approved to join the benefit plan will have reduced dental coverage in the first year of coverage. After the first year, the annual maximum dental coverage is restored to the full amount.
Late applicant rules also apply to changes in the employee's family situation, including:
- Birth of a child – you have 31 days from the date of the child’s birth to add them to the benefit plan.
- Co-habitation – you have 31 days from the date of eligibility (varies, each insurer has their own guidelines) to add a new spouse or common-law spouse.
- Spouse loses coverage – you have 31 days from the date that coverage was lost.
Please check your administrative or employee booklet for additional information, or contact us.
What happens if an employee opted out of the benefit plan and now wants to enrol?
If an employee wants to opt out of the benefit plan, you will need to ensure you have a waiver of liability letter signed and on file. Most benefit plans require 100 per cent participation, so allowing opting out is not recommended. If you have an employee who refuses to join the benefit plan, and then later decides he does want coverage, he could be denied coverage all together or would be a late applicant. The best way to avoid this is to make coverage mandatory. Employees who have a spouse with coverage should waive the health and dental coverage and apply for all other benefits or they may not be allowed on the plan if their spouse loses coverage.