Enrollment Guidelines
Enrollment Forms
All enrollment and change forms are available online.
Regence Online Enrollment
This Web-based service for groups with 25 or more enrolled employees allows group administrators and employees to electronically perform all enrollment and change transactions throughout the year. It also lets you check the status of any employee’s enrollment and reminds you of key enrollment events (i.e., COBRA eligibility). Information and login for this service is available online.
Eligible Employees
Eligible employees and dependents may enroll only on the new-hire date, as the result of a special enrollment event, upon the group’s renewal, or when they get married or acquire a newly eligible dependent. All applicants must be employed full-time unless expressly negotiated to the contrary in the group’s contract. In most cases, an eligible dependent is a lawful spouse or unmarried dependent child under the age of 26.
When a New Employee is Hired
- Have each new employee complete an Application for Enrollment/Waiver form as soon as they are hired and promptly send it to Regence, ATTN: Membership Department #4. Before submitting an application form, please review it to make sure that all necessary areas are complete and legible. There may be a delay in the processing of incomplete or illegible applications.
- New employee applications are accepted in accordance with your group’s new-hire agreement as described on your Group Application Form.
- Employees should fill out all appropriate sections on the application form.
- Be sure to have the employee sign and date the application.
- The Group Health Questionnaire must accompany all applications for newly eligible employees in groups of 2-50 employees.
- The Group Health Questionnaire must accompany all applications for employees enrolling with Special Enrollment Period rights.
- All employees in groups of 2-50 employees who are waiving coverage for themselves and all dependents must complete the Small Group Employee Waiver Form.
- The current/prior coverage section of the Application for Enrollment/Waiver must be completed to ensure that the employee’s prior coverage is credited correctly.
- We must receive applications and health statements within 30 days of the effectivedate to be able to process them in a timely manner.
- Do not send the premium for your new hires until they appear on your billing statement. We will bill retroactively if necessary.
- Keep a copy of the application form for your records.
- Any employee or dependent applying for coverage after the new-hire date may enroll only at your next annual enrollment period (and up to an 18-month Preexisting Condition (PEC)waiting period) unless he or she qualifies for a Special Enrollment Period (SEP) prior to the annual enrollment period.One type of Special Enrollment Period is a 30-day enrollment period for an employee (or dependent) who was eligible for coverage but declined to enroll initially because of other coverage and who has now lost that other coverage due to certain circumstances. Those circumstances are COBRA expiration, if the other coverage was COBRA; the loss of eligibility for the other coverage (e.g., termination of employment, legal separation, divorce, or death); or the complete termination of employer contribution to the other coverage. Other Special Enrollment Periods follow an employee’s acquisition of a new dependent by marriage, birth, adoption, or placement for adoption. The 30-day Special Enrollment Period is the 30 days immediately following COBRA expiration, loss of eligibility, termination of employer contributions, or dependent acquisition.
Detailed information outlining qualifications and requirements is available in the “Enrollee Booklet,” which is attached to your group agreement.
- The Preexisting Condition Exclusion (PEC) provides for a period of time during which care of
preexisting conditions will not be covered. A preexisting condition is one for which medical
advice, diagnosis, care or treatment was recommended or received within the six-month period
before the enrollment date for coverage. The enrollment date is the earlier of the effective date
of coverage or the first day of any new hire or probationary period your group requires
employees to serve before they are eligible for coverage. The exclusion period for coverage of
preexisting conditions may last up to 12 months (or up to 18 months for those who did not
enroll when first eligible and who do not enroll during a Special Enrollment Period). The PEC
does not apply to a pregnancy or to a child who becomes covered within 30 days of birth,
adoption or placement for adoption and remains covered without a break in coverage greater
than 63 days. The length of the PEC may be reduced if the employee has evidence of prior
creditable coverage with no break in coverage of more than 63 days. Evidence of prior
coverage consists of a certificate of creditable coverage from a previous carrier. If this is not
available, Regence will help the member obtain one or will explain other ways in which
creditable coverage can be demonstrated.
- We must receive applications in our office within 30 days of the date of the event. All applications received after the 30 days will be considered late and will not be effective until the group’s next annual enrollment.
- We will send you new-hire letters of confirmation for your records and to verify that we have received the required documents and established an effective date of coverage. We provide these letters as a courtesy; inadvertent failure to send one in any instance shall not create any liability.
When an Employee Refuses Coverage
If you have employees who do not enroll, please have them complete the appropriate waiver form. Keep a copy of this form to prevent future legal problems.
When an Employee is Rehired
When an employee is rehired or returns to work within 30 days of beginning a layoff or leave of absence, Regence will reinstate the employee if we receive a written request within 30 days of cancellation of coverage. If the rehiring or return to work occurs more than 30 days after the cancellation, the employee is considered a new hire and will be subject to new hire guidelines.
When an Employee’s Name or Address Changes
The employee should complete a Change Form “E-27” within 30 days after the change, showing their identification number, former name, new name, date of marriage or divorce, or change of address. Review the change form to make sure it is complete and legible. There may be a delay in processing incomplete and/or illegible change forms. Members can also make address changes at www.myRegence.com.
When an Employee Wishes to Add or Delete Dependents
Enrolled employees should submit a Change Form “E-27” within 30 days after the marriage date, date of birth, date of adoption or placement for adoption, or date of dependent coverage termination.
Dependents who apply after the 30 days will have to wait for your next annual enrollment period and satisfy up to an 18-month Preexisting Condition requirement unless a Special Enrollment Period occurs sooner. Regence will assign the effective date.
We will send you status-change letters of confirmation for your records and to verify that we have received the required documents and established an effective date of coverage. We provide these letters as a courtesy; inadvertent failure to send one in any instance shall not create any liability.
When a Dependent Ceases to be Eligible for Group Coverage
For all fully insured groups, when an unmarried dependent child approaches the age of 26, we will send you and the employee a letter announcing the cancellation of the dependent’s coverage due to a loss of eligibility. To allow for time to arrange for other coverage, we will send these letters about one month before the dependent child’s 26th birthday. We provide these letters as a courtesy; inadvertent failure to send one in any instance shall not create any liability.
When an Employee has a Disabled Dependent Child
In compliance with state law, certain mentally or physically disabled dependent children on two-party or family contracts are covered, even beyond the limiting age, unless:
- the child marries;
- the child ceases to be disabled;
- the child ceases to be dependent upon the employee or employee’s spouse; or
- the employee’s coverage ends.
Note:
In order to extend benefits past the limiting age for your group coverage, we will need to receive proof of disability and dependency within 30 days of the dependent’s reaching the limiting age. We also may need evidence of continued disability again in the future.
When an Employee Reaches Age 65
- You must give the employee the appropriate creditable/non-creditable drug coverage letter regarding enrollment in Medicare Part D.
- In groups sponsored by employers with fewer than 20 employees, an employee who qualifies for Medicare on the basis of age may, if actively employed, continue in the group with the same benefits, but Medicare will pay as primary. (However, the group coverage will not duplicate benefits provided by Medicare.)
- Groups sponsored by employers with 20 or more employees are required to offer active employees age 65 or over and dependents age 65 or over of active employees of any age the same group health care benefits offered to other employees and dependents under age 65. If such employees and dependents qualify for Medicare on the basis of age, their group health care coverage will be primary to Medicare.
When a Member Becomes Eligible for Medicare Through Disability
- For groups sponsored by employers with fewer than 100 employees, an employee or dependent who qualifies for Medicare on the basis of disability may continue on the group coverage with the same benefits, but Medicare will pay as primary. (However, the group coverage will not duplicate benefits provided by Medicare.)
- Groups sponsored by employers with 100 or more employees are required to offer disabled active employees and disabled dependents of active employees the same group health care benefits offered to other employees and dependents. If such employees and dependents are entitled to Medicare on the basisof disability, their group health care coverage will be primary to Medicare.
When an Employee Retires
At age 65, a retiring employee may apply to enroll individually in a BlueCross and/or BlueShield Medicare Supplement or Medicare Advantage plan in the state where they reside. If application is received within six months of enrolling in Medicare Part B, the application will not be subject to underwriting requirements. Retirees under age 65 may apply for an available individual plan if medically qualified or for group conversion if they apply within 60 days after termination of group coverage.
When an Employee Leaves Your Group
Unless other arrangements have been made specifically for your group, an enrolled employee must be terminated from the group coverage as of the end of the payment period in which the employee becomes ineligible by reason of termination of employment, retirement, layoff, illness, expiration of authorized leave of absence (not to exceed 90 days), or upon change to an ineligible classification or other causes.
- Draw a single line through the employee’s name on the group bill and list the name and contract number on the Group Change Form.
- Designate the termination code on both the Group Change Form and group billing, and then deduct the corresponding premium from the total amount due.
When An Employee Ceases To Be Eligible For Enrollment With Your Group, Membership Can Be Continued
Under federal legislation known as COBRA and similar state law, some employees and dependents who lose eligibility may continue or extend group health plan coverage on a voluntary basis. The employee or dependent will pay for the cost of the coverage (unless you choose to pay for or contribute to it). As the plan administrator, you have extensive duties under COBRA or Utah State Continuation. One of these duties is the distribution of a general description of COBRA to employees and dependents when they initially become covered by your plan (or when COBRA first applies to your plan, if that occurs later).
Also, as a plan administrator, if you fail to give notice to a former employee of the availability of COBRA or Utah State Continuation within the timeframes that are legally required, Regence cannot accept the enrollment application under COBRA or Utah State Continuation.
- COBRA
Coverage may be available under COBRA when coverage would be lost due to any of the following reasons:
- An employee is terminated from employment (except for gross misconduct) or has a
reduction in work hours below those necessary to be eligible (coverage may be continued
by the employee and dependents).
- An employee dies (coverage may be continued by the dependents).
- An employee becomes divorced (coverage may be continued by the former dependents).
- An employee becomes entitled to receive Medicare benefits (coverage may be continued by the dependents).
- A dependent child ceases to qualify as eligible (coverage may be continued by such child).
- The employer files a Chapter 11 bankruptcy petition (retirees and their dependents can retain coverage if the retiree loses coverage within one year before or after the bankruptcy
is filed).
You are responsible for notifying your COBRA administrator within 30 days of the occurrence of one of these events. Your COBRA administrator may be your own Human Resources or other department or an outside entity, but it is not Regence or HealthWise. Employees or dependents are required to inform the COBRA administrator within 60 days of a divorce, legal separation, or child’s loss of eligibility, so it is important that you clearly identify the COBRA administrator for them. The COBRA administrator is then required to notify the employee and/or dependents within 14 days of the availability of COBRA.
COBRA must be elected, through the appropriate forms, within 60 days of the later of (i) the date group coverage otherwise would be lost or (ii) the date of notice of the availability of COBRA coverage. Appropriate initial premium for COBRA must be paid within 45 days of the election of COBRA. The appropriate initial premium is the amount corresponding to the period from the date that group coverage otherwise would have been lost through the premium due as of the date of premium payment. After the initial premium, the COBRA participant’s ongoing premium is due on the same day the group’s premium is due. There is a 30-day grace period.
COBRA can generally be maintained for a maximum of 18 months following a termination of employment or reduction in working hours and a maximum of 36 months following the other qualifying events. There are, however, circumstances that can result in an earlier termination of COBRA or an extension of these maximums. (See the COBRA booklet at for more details.)
- Utah Mini-COBRA (State Continuation)
Where COBRA is not available, continuation of coverage may be available to employees and dependents under Section 31A-22-722 of the Utah Code. Generally, you must offer Utah State Continuation of benefits as follows:
- To an insured employee, spouse and children, regardless of the reason that group coverage
would otherwise have terminated (except for termination due to gross misconduct);
- To an insured spouse and children upon the death of the insured employee through whom
they were covered;
- To an insured spouse and children who would otherwise lose coverage as a result of the
spouse’s loss of status as a family member of the insured employee (e.g., divorce);
- To an insured child who loses his or her status as a family member of the insured
employee (but such continuation coverage shall be solely for that child).
The maximum continuation of benefits period for each of the above events is six months; however, there are circumstances that can result in an earlier termination of the continuation of benefits.
Though otherwise qualified for continuation of benefits, an insured shall not be offered Utah State Continuation if:
- The insured has not been continuously insured and eligible under your group policy (or its predecessor) for at least the six months immediately prior to termination; or
- The group coverage was terminated because of the insured’s failure to pay any required contribution toward premiums; or
- The insured acquires other group coverage covering all preexisting conditions (including maternity) for which coverage existed under your group coverage; or
- The insured who would be extending benefits performed an act or practice that constitutes fraud or made an intentional misrepresentation of material fact under the terms of your group coverage.
You must notify the terminated insured in writing of their right to Utah State Continuation within 30 days of the termination of group coverage. Notification must include the amount, time, place, and manner for premium payment. You are not required to make any contribution toward premiums for extending insureds. Extending insureds make premium payments in full to your group.
Utah State Continuation must be elected through the appropriate forms, and the initial premium must be paid within 60 days after losing group coverage. Where written application and premium are received within the 60 day period, the accepting insured’s coverage continues, without interruption, from the date group coverage is terminated.
For additional information, refer to the COBRA booklet.
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