Special Enrollment

Employees and dependents are eligible for a special enrollment period upon loss of medical coverage or if a person becomes a dependent through marriage, birth, adoption, placement for adoption or legal guardianship. The employee must request enrollment for the affected employee or dependent no later than 31 days after the loss of other coverage or the event. A special enrollee is not considered a late enrollee.

Adding Newborns

In order for your newborn to be covered from birth, the newborn child must be added within 31 days of the event (There is no automatic enrollment). Coverage will be effective the date of the birth, assuming the completed enrollment form is received within 31 days of birth. To add the newborn within 31 days, a copy of the hospital certificate of birth will be requested (to be followed up with the actual state-issued birth certificate when available).

Children adopted, placed for adoption, or for whom legal guardianship has been granted

These dependents may also be added within 31 days of the event. In order for grandchildren to qualify under MPR plans, the employee must have legal guardianship of the minor granted through the courts.

Marriage – New Spouse

Must be added within 31 days of the event. Coverage will be effective the 1st of the month following the marriage date. Documentation, usually a current official marriage certificate, is required.

Common Law Spouse is based on the state in which a participant lives and is only allowed in Kansas. In addition to the enrollment application, a Common Law Affidavit is required before the Common Law spouse is covered.

QMCSO (Qualified Medical Child Support Order)

Legal documentation must be submitted to Benefits Management. If the employee is not enrolled for coverage at the time the order is received, they must enroll at that time in order for the child to be covered. If a dependent covered by QMCSO lives outside of the HMO service area, a PPO plan will be the only option for coverage.

Loss of Coverage

Provided the person was covered under a group health plan and stated in writing that was the reason for declining enrollment, coverage will begin the 1st of the month following the loss of coverage date. Request must be submitted within 31 days of coverage loss. For full details, review the Special Enrollment section of the medical plan document.

Loss of eligibility for Medicaid or a State Child Health Insurance Program (SCHIP)

Provided a request for enrollment is made within 60 days after the loss of eligibility.

Determined to be eligible for premium assistance by Medicaid or a SCHIP

Including under any waiver or demonstration project conducted under or in relation to such a program, provided a request for enrollment is made within 60 days of the determination of assistance.

Leave of Absence or Layoff

Coverage may continue for up to 90 days after the date in which the person last worked as an active employee (depending on the member entity’s personnel policy) and runs concurrent with any FMLA continuation period.

FMLA

Follow standard law for FMLA.

Disability

Coverage can be continued following the latest of these dates: (1) for up to 90 days that next follows the date in which the employee last worked as an active employee, if allowed by the Member entity’s policy, or (2) the end of the period in which the person was entitled to regular pay as an active employee or through personal paid time off, sick leave, vacation time or other defined salary compensation of the Member entity.