Benefits

How to Deal with Late Benefits Applications

Apr 12, 2018
·
3
min read

Before we take a look at what late benefits applicants are and how to avoid them, it is easier to understand if you know why the concept exists in the first place.

For most benefit plans, insurance carriers abide by a 30-day rule that requires employees and their dependents enroll for group benefits no later than 30 days of becoming eligible for coverage.

If this is not the case and employees were given the option to join your benefits plan whenever it suited them, they would likely only join when they needed to submit a claim. Not only would this be a risk to the insurance company, but the cost of your group plan would skyrocket as the ratio of claims costs to premiums paid would become very out of balance.

What happens if an employee needs to be enrolled, add a dependent, or make a coverage change after the 30-day window closes?

They become classified as a late applicant. This does not mean that the enrolment or the change is no longer possible, but it does mean at the least:

  1. Evidence of Insurability (additional paperwork, doctor's visits or medical testing) may be required, and
  2. The insurance company may deny the request for coverage.

If the carrier denies coverage, there is little recourse for the employee. They will not be insured with your group plan and will be excluded from this part of their compensation package. This could open up your organization to various liabilities, so being on top of your benefits administration should be high on your priority list.

To mitigate the risk of late applicants, consider taking these steps:

  • Enroll all new employees at their hire date - this reduces the likelihood that you will forget their enrolment later on, and the carrier will apply the plan designated probation period
  • Create (and stick to) a clearly defined process for adding new employees/dependents to your plan.
  • Make enrolment in your group benefits plan a mandatory condition of employment
  • Have employees sign a carefully worded waiver if they are eligible but decide to decline to enroll in your group plan

Remember those timelines! For employees, their eligibility window closes 30 days from the end of a waiting period and for dependents, it's 30 days from the life-change or event: 30 days from birth, marriage, cohabitation anniversary, etc.

If you think you have a late applicant case or if you have any questions about eligibility or timeframes, contact us, and one of our benefits support specialists will be happy to help! See Humi Benefits

Topics in this article
About the Author
Hilary LambHilary Lamb

Hilary is a Client Experience Manager at Humi and has a penchant for salty snacks.

Subscribe to Humi Blog
You can unsubscribe anytime. Privacy policy.

Get HR insights from Andrea,
Subscribe to Think with Humi

Written by a real HR expert

Yes, Andrea is actually writing them every two months. Got questions about something in an email? No problem – reply to the email and she’ll get back to you.

Not your typical HR content

We know that HR is evolving and you don’t need to be told the same advice you've been hearing for years.

Practical resources

A list of resources that we find useful. If a template or an article has helped us, it’s probably going to help you too.

Hey there 👋 my name is Andrea Bartlett.

I’m the Director of HR at Humi, and I’m obsessed with all things people and human resources. Throughout my time working in a range of industries, I’ve learned that one thing is clear: the world of work is changing and HR professionals are leading the charge. 

I believe that businesses should know their people as well as they know their product. But people are complex, and the solutions aren’t always easy. That’s how Think with Humi will help. 

Written by me, this newsletter is designed to give you insight into the relevant and raw people challenges, and give you the tools to enable you to continuously to shape the future of work. 

Written by a people leader, for people leaders.

Continue reading

Explore Topics