Eligibility - Group Enrollment Process
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Who’s eligible to enroll under your group plan?
An eligible employee meets the guidelines established in the Evidence of Coverage (EOC) and Group Enrollment Agreement (GEA).
An eligible dependent meets the following requirements:
- An employee’s lawful spouse unless legally separated.
- An employee’s child or the child of the employee’s lawful spouse under age 26.
- A child who is dependent upon an employee as his/her legal guardian.
- An employee’s registered domestic partner.
When can an eligible employee and eligible dependent enroll?
- Initial Enrollment: The timeframe eligible employees and eligible dependents may enroll in your group health plan.
- Group Open Enrollment: A period of at least 31 days may be held at least once a year allowing eligible employees and eligible dependents to enroll.
- Late Enrollment: In the absence of a special enrollment period, an employee cannot apply for coverage as a late enrollee. An eligible employee or any eligible dependents can enroll in the future if he/she experiences a qualifying life event or during the plan’s open enrollment period.
- Special Enrollment: An eligible employee can change or enroll in your group plan if he/she has experienced a life event — like getting married, having a baby, losing other coverage, or moving — this qualifies him/her for a special enrollment period.
- He/she must submit proof, such as a birth certificate, court appointee legal guardianship papers, adoption papers or marriage license to Health Plan of Nevada within 31 days of experiencing his/her qualifying life event.
How do eligible employees and eligible dependents enroll?
Each eligible employee, interested in receiving health coverage under your group plan, must complete an enrollment form during one of the enrollment periods or within 31 days of becoming eligible. To enroll as an eligible dependent, he/she must be listed on the employee’s enrollment form.
It’s very important for each employee to fill out the enrollment application correctly. Failure to complete every section and/or sign may delay the implementation process. Once an application(s) is complete, please give it to your Group Services representative.
What if an employee’s or a dependent’s eligibility status changes?
If one of your employees experiences a qualifying life event or change in employment status, which affects his/her eligibility or his/her dependent’s eligibility to receive health benefits under your group plan, it’s your responsibility to provide written notice within 31 days of the event or change. Simply complete a membership change form, enrollment form or approved electronic method and send it to your Group Services representative.
Common life/family events may include but are not limited to:
- Marriage or commencement of domestic partnership
- Divorce, legal separation or termination of domestic partnership
- Addition of a child via birth or adoption
- Death of the health plan member or his/her dependent(s)
- Change of home address outside the plan’s service area
Common employment status changes may include but are not limited to:
- Employee becomes newly eligible to receive coverage
- Employee becomes ineligible to receive coverage or loses employment
- Spouse/domestic partner obtains health benefits in another group health plan
- Spouse/domestic partner loses employment or coverage in another group health plan
If proper notice is not provided, which would have resulted in termination of coverage, Health Plan of Nevada shall have the right to terminate coverage.