Insurance Companies Enforcing Eligibility Time Frame Deadlines

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All group policies or contracts contain a specified time period for employers to submit enrollment additions, changes, and terminations.  The insurance companies usually will accept new hire enrollments and changes within 30 days.  They also prefer to receive employee terminations within a month, but often will process cancellations up to 60 days after the last day worked. These time frames were established so that insurers could accurately update their claim and billing systems, quote benefits to providers, and process premium credits/debits back to employers.

When insurance companies do not receive these enrollment changes within the allotted time frame, problems can arise for both the employer and the employee.  In the past, the insurance companies would review each situation, looking to see if claims had been submitted, and would make a determination as whether or not to allow a “retro change” exception.  We have heard that most of the carriers will no longer review these requests and will be sticking to the eligibility administration time frame noted in the policy.  

Here are some important reminders and steps that employers can take to make sure your employees’ eligibility is accurate and your bill is correct each month:

  1. Become familiar with the “retro change” time period stated by your carrier.  Most are 30 days, however, yours may be different.
  2. Use the “Administration” portal of your insurance company’s website to frequently review, update, and submit employees’ eligibility.  (If you aren’t currently using the carriers’ tools, we can help set you up and train you.)
  3. Communicate with employees about the importance of providing you with timely notice of any “Qualifying Events” throughout the year.  Employees can usually make enrollment changes within 30 days of a Qualifying Event, but the insurance company must receive changes very quickly in order to honor the effective date or provide a premium credit for terminations.
  4. Carefully review your premium statement and employee enrollment listing each month.  Make sure any premium adjustments are reflected on the next statement.  If something is missing, ask right away.
  5. Periodically check to make sure employees’ payroll deductions match the coverage tier you are being billed for.  If you are being billed for employee + spouse coverage, make sure their payroll deduction isn’t just for single coverage.

Business Benefits Insurance Solutions is a full service agency.  Please let us know if we can help you with your enrollment and eligibility needs.