Late Applicants

Once an employee has completed your company’s probation period (if applicable), they enter the eligibility period, which is typically 30 days. The employee must opt into group benefits during this time to join the group benefits plan seamlessly. If they wait until after the eligibility period to opt into the plan, they are considered a late applicant.

Late applicants may face the following implications:

• Denial of coverage.
• Proof of insurability requirements (medical underwriting) and premium adjustments.
• Reduced insurance maximums (for example, a significant reduction in dental maximums during the first 12 months).

The eligibility period is applicable not only to employees, but to family members as well. Those with family coverage must add new family members (including marriage, cohabitation, and birth of a new child) within 30 days.

Employers are responsible for informing their staff of the eligibility period to avoid being liable for any of these implications.

Waiver of Coverage:

There are only two circumstances in which employees may be able to opt out of group benefits coverage:

• During a leave-of-absence. If an employee is on disability, maternity, or some other type of leave where they cannot be physically present at work, they can opt out of coverage during that time. If the employee returns to work, coverage and contributions resume.
• When there is comparable coverage elsewhere. An employee may have a spouse whose employer also offers employer-sponsored health benefits. The employee will have to provide proof of spousal coverage, including the insurer name and policy number.

It is important to note that life and disability insurance are mandatory for employees if offered in the benefits plan. Employees may only forego health and dental coverage under the above circumstances.

If an employee would like to waive coverage, a Benefits Waiver Form must be completed. Each carrier has their own customized form that they will provide to you and your employee.

If the employee loses their spouse’s coverage at any time, they can enroll in your company’s plan within 31 days of the coverage termination.