Employee status changes

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Qualifying event guidelines

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Applications must be received within 31 days of other coverage termination. This does not include other coverage sponsored by your group.

Effective Date: 
Date following other coverage termination

Forms Needed: 
Employee Application
Qualifying Event Questionnaire or Certificate of Creditable Coverage from Prior Carrier

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Employee, spouse and newly acquired dependents may apply or Employee may add spouse and newly acquired dependents. Must receive application after the marriage date but within 31 days of marriage.

Effective Date: 
Date of Marriage

Forms Needed: 
Employee Application

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Employee, spouse, qualified dependent and newborn may apply, or Employee may add spouse and/or newborn. Other dependents added at this time may be considered late enrollees. Premiums will be billed for coverage back to the newborn’s date of birth and interest may be applied.

Application to add a newborn should be received within 60 days of the birth, but will be accepted for up to 1 year from the newborn’s date of birth. Application to add other dependents must be received within 31 days of the birth. 

Effective Date: 
Date of Birth of Newborn

Forms Needed:
Employee Application

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Employee, spouse and new dependent may apply, or employee may add spouse and/or new dependent. Application to add adopted child must be received within 60 days of adoption or placement. Application to add other dependents must be received within 31 days of adoption or placement.

Effective Date: 
Date of Order for Legal Adoption or Placement

Forms Needed:
Employee Application
Copy of Court Order Placing Child for Adoption

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Employee may add legal ward. Employee needs to be covered under the plan at the time the legal ward is declared in order to enroll the appointed ward. Application must be received within 31 days from date of legal ward declaration.

Effective Date: 
Date of Legal Custody or Placement of Legal Ward

Forms Needed:
Employee Application
Copy of Court Order Placing Child with Employee or Spouse
Verification of Residence and Percentage of Support

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Spouse and dependent(s) may join the group plan. Application must be received within 31 days of transfer to the United States.

Effective Date: 
Date of Arrival in the USA

Forms Needed: 
Employee Application
Questionnaire & Copies of Visas are Required

girl hugging military dad

 

 

If a person is absent from a job less than 31 days, they must report to the employer by no later than the beginning of the first full regularly scheduled work period on the first full calendar day following the completion of the active service.
 
If the active service lasted more than 31 days, but less than 181 days, the person must report to the employer no later than 14 days after the completion of the active service. If active service lasted for more than 181 days, but less than 5 years, the person must report to the employer no later than 90 days after the completion of the active service.

Effective Date: 
Eligibility will assign effective dates based on the dates requested by the group for those employees from military leave. If a group indicates an effective date equal to the date an Employee returned from the military, Dean Health Plan will honor that date.
 
If a group applies a probationary period for a returning employee, Dean Health Plan will honor that request as well.

Forms Needed:
Employee Application

Employment status changes

Part-time to full-time or temporary to permanent employment

An employee who changes from part-time to full-time employment on a permanent basis or from temporary to permanent employment is eligible for coverage after serving the probationary period as a permanent employee listed on the Group Master Policy.

The probationary period is established based on the full-time, permanent employment date. We may require additional documentation to support this change.

Note: The 1995 Wisconsin Act 289 does not allow an employer to require an employee to work more than 30 hours per week to be eligible for group health insurance coverage.


Lay-off/disability

If an employee is not active at work and/or doesn't meet the eligibility guideline (30 hours per week in most cases), our standard policy is the employee should be terminated from active coverage immediately and offered  COBRA/Continuation.

If your group has a special policy for these situations where employees are not terminated from active coverage immediately – or you are offering a severance agreement that includes extended health insurance benefits – you must contact your Account Manager to determine if the policy is acceptable to us.

Example: Laid-off employees receive an additional month of coverage from the date of lay off before being terminated and offered COBRA/Continuation. If the request is approved, the special provision is effective the first of the month following approval.

Rehired previously terminated employees

If you've rehired an eligible employee whose coverage was terminated because of:

  • employment termination
  • temporary lay-off
  • leave of absence
  • temporary reduction of hours

that eligible employee and previously covered dependents are eligible for coverage after completing the probationary period you've established and listed on the Group Master Policy.

There is an exception to this for large group employers. If an employee is rehired within 13 weeks of the date of termination, the employee is eligible for coverage immediately upon date of hire.