An eligible employee is a person who:
See your Group Master Policy for the eligibility statement for your group.
View Sample Group Master Policy
Learn more about enrolling your employees
Newly hired, eligible employees and their dependents are eligible for coverage after serving the probationary period established by your group and listed in your Group Master Policy.
To change the probationary period, you must notify your Account Manager in writing before the date of the change. The probationary period cannot extend beyond 90 days.
Note: coverage for the eligible employee and any qualified dependents may not become effective if the eligible employee is not actively at work on the effective date. See your Member Certificate for further details.
Employees and their dependents who initially waived coverage may be eligible for benefits later due to a qualified status change or event. See our Qualifying Events Guidelines for more information.
If your group offers PPO and/or POS segments, the following employees are eligible to enroll in those segments:
The HMO Network is available in the following counties: Adams, Columbia, Crawford, Dane, Dodge, Fond Du Lac, Grant, Green, Green Lake, Iowa, Jefferson, Juneau, Lafayette, Marquette, Richland, Rock, Sauk, Vernon, Walworth and Waukesha.
See HMO Network (PDF)
Individual plans only available in Dane, Rock and Sauk counties. Group plans available in Dane, Dodge, Fond du Lac, Green, Rock and Sauk counties.
See group plan Focus Network (PDF)
Option for employees that are outside of the service area.
PPO Network available in the following counties: Columbia, Dane, Dodge, Fond Du Lac, Grant, Green, Iowa, Jefferson, Lafayette, Richland, Rock, Sauk and Waukesha.
See PPO Network (PDF)
An eligible dependent is defined as the subscriber's:
If the subscriber’s dependent is disabled, coverage may be available beyond age 26. To qualify as disabled, a subscriber’s dependent must be approved by the Underwriting Department. See your Member Certificate for definition of disabled dependent.
If you have 51 or more employees, or you use a third party administrator for benefits enrollment, you may consider sending us a HIPAA-compliant Electronic Enrollment Transaction (834) in lieu of Employee Application for Group Coverage forms.
If your group is interested in sending electronic enrollment transactions, contact your Account Manager to get started, or read more about HIPAA transactions.