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Open Enrollment Period

PW_034744

Adding a Spouse and/or Dependent
To add eligible dependents to an employee's coverage, follow the guidelines below. If the dependent is not added within these time frames, then in most cases, the dependent cannot be added until your next open enrollment period (and may be subject to pre-existing condition waiting periods).  

When you add Submit a completed application within: Along with: Coverage will be effective:
      Anthem HealthKeepers
Anthem KeyCare/ BlueCare
A newborn dependent child (including a child adopted by the employee or placed with the employee for adoption within 31 days of birth) 
31 days after the newborn’s birth, adoption, or placement for adoption 
the appropriate premium payment (if sending with group bill) 
On the date of birth 
On the date of birth 
Other adopted children 
31 days after the date the child was adopted by the employee or placed with the employee for adoption 
proof that the adoption has occurred or is pending and the appropriate premium payment (if sending with group bill) 
On the day the child is adopted by the employee or placed with the employee for adoption 
On the day the child is adopted by the employee or placed with the employee for adoption 
 
Remember to notify us as quickly as possible of any adjustment, so we may keep your account as current as possible. In most cases, retroactive changes are limited and will not extend more than 60 days before the first of the month in which we receive them (See the “Retroactive Adjustments” section below).  
 
Open Enrollment
Open enrollment is the period of time during which your employees select their health care benefits for the upcoming year. Open enrollment should be held approximately one to two months before the desired effective date, typically the date your group renews its coverage with us.  
However, there are other times when open enrollment for your group may occur:  
If you allow your employees to pay their health care premiums with pre-tax dollars under your "premium conversion" or cafeteria plan, you may also hold an open enrollment period prior to the beginning of the cafeteria plan year, if different from your renewal date.
An open enrollment period may also occur if, as an employer, you change your premium contribution off-renewal. For example, if you had been contributing 50% toward premium, and three months after you renewed you increased your contribution to 75%, you would be able to hold another open enrollment.
 
If your group is not meeting group eligibility guidelines for minimum employee participation that is discovered during an audit, Anthem may grant your group a special enrollment period in order to increase participation.  
 
Late Entrant Policy
Employees and their dependents who want to enroll for coverage under your group policy after your group's open enrollment is over can only do so:  
when they first become eligible for coverage; or
during a "special enrollment period" following certain specified events (described below).
 
Those who elected not to enroll when they first became eligible and are not entitled to a special enrollment period are called "Late Entrants" and must wait until your company's next open enrollment period to enroll.  
The “special enrollment period” is the 31 days immediately following one of these events, during which eligible persons may be enrolled:  
The employee’s marriage
The birth of the employee’s child
The employee’s adoption of a child, or a child’s placement with the employee for adoption
An eligible person’s loss of coverage under another health plan due to the employee’s divorce or legal separation
An eligible person’s loss of coverage under another health plan due to the death of the employee's spouse
An eligible person’s loss of coverage under another health plan due to a change in the employment status of the employee's spouse (including termination of employment or reduction in work hours)
An eligible person’s loss of coverage under another health plan (such as that of the employee's spouse) due to termination of the employer contribution
An eligible person’s exhaustion of COBRA coverage under another health plan
An eligible person's loss of coverage under another plan which is an HMO plan, due to no longer living or working in the HMO's service area (unless other coverage under the plan is available to the individual).
An eligible dependent's loss of eligibility for coverage under another plan; for example, due to attaining the limiting age.
An eligible person's loss of eligibility for coverage under another plan because that plan no longer provides coverage to a particular class of persons.
An eligible person's loss of coverage under another plan because the benefit option was discontinued when the insurance company ceased operating in the group market (unless coverage under another option is available to the individual).
 
Enrollment other than during open enrollment period or a "special enrollment period" described above will also be allowed in certain other limited circumstances. These circumstances include:  
the issuance of a court order requiring an employee to provide health coverage for his or her non-custodial children.
Changes necessitated by the provisions of the cafeteria plan of the employee's spouse. Certain changes in coverage or cost of benefits provided under a cafeteria plan may permit election changes under that plan by the employee's spouse. Anthem or one of its affiliated HMOs will accommodate these situations by allowing enrollment changes by the affected employee that are consistent with the change made by the spouse. For example, a spouse's employer cafeteria plan may provide that elections may be changed if benefits for all participants are "significantly curtailed" or if there is a significant change in the amount participants must contribute. If the spouse changes his or her election for one of these reasons, Anthem or one of its affiliated HMOs will allow the employee to make a corresponding enrollment change even if it is not your group's open enrollment period.
 
If any of these circumstances applies to an employee's enrollment, attach a letter of explanation to the employee's application. If this documentation is not received, the application cannot be processed.  
Following are several examples for determining whether an employee is a Late Entrant:  
An employee of ABC Company was covered by his spouse's health plan at another company. When first eligible, he declined the Anthem KeyCare plan offered by ABC Company. Now his spouse is laid off from her position, and the employee of ABC loses his medical coverage under the spouse's plan. This ABC employee would not be considered a Late Entrant and he and his spouse would be allowed special enrollment in ABC's Anthem KeyCare plan provided the couple enrolls within 31 days of their change in coverage.
An employee of ABC Company is covered by his spouse's health plan at another company. When first eligible, he declined the Anthem KeyCare plan offered by ABC Company. Three months later, this employee has decided that the Anthem KeyCare plan provides desirable coverage that his wife's health plan does not. He wants to enroll in Anthem KeyCare, but because his situation does not qualify for special enrollment, he must wait for open enrollment.
An employee of ABC Company was covered by his spouse's health plan at another company. When first eligible, he declined the Anthem KeyCare plan offered by ABC Company. Now the employee and his spouse divorce, and he is no longer covered by her health plan. This ABC employee would not be considered a Late Entrant and would be allowed special enrollment in ABC's Anthem KeyCare plan provided he enrolls within 31 days of his change in coverage.
An employee of ABC Company was covered by his spouse's cafeteria plan at another company. When first eligible, he declined the Anthem KeyCare plan offered by ABC Company. Now his spouse's health plan has undergone a significant curtailment in benefits or a significant change in cost (i.e., benefit reduction affecting all participants or contribution percentage changes that adversely impact the employee). This ABC employee would not be considered a Late Entrant and he and his spouse would be allowed enrollment in ABC's Anthem KeyCare plan provided the couple enrolls within 31 days of their change in coverage.
 
Retroactive Adjustments
When enrollment information is sent to us more than 31 days after the requested effective date, the membership request is considered to be retroactive.  
Two steps must be completed within the given time periods to enroll an employee on a retroactive basis and have the coverage be effective on the requested effective date:  
The employee must have completed and signed the application within 31 days of the date of eligibility.
The request for retroactive coverage must be received from the group within 60 days of the employee's date of eligibility.
 
If you wait longer than 60 days from the employee’s date of eligibility to send in the request, we will consider processing the enrollment but coverage will not be effective more than 60 days prior to the 1st of the month in which we receive your request. These guidelines apply to all insured groups. They also apply to self-funded groups and the shared risk HMO groups unless a previous exception has been made for your group.  
The following are adjustment examples for a retroactive effective date.  

Example 1:
May 1 
Group hires a new employee. Employee is eligible for coverage on May 1 and completes and signs application by May 31. 
June 28 
Group mails in the application for new member’s coverage effective May 1 with appropriate premium. We will enroll the employee retroactively to May 1 because the application was completed and signed within 31 days and the request was received by us within 60 days. 
Example 2:
May 1 
Group hires a new employee. Employee is eligible for coverage on May 1 and completes and signs application by May 31. 
August 8 
Group mails in the application for new member’s coverage on July 30. We will add the new member with a June 1 effective date because the change was not received within 60 days and June 1st is 60 days before the 1st of the month in which we received the request. 
Example 3:
May 1 
Group hires a new employee. Employee is eligible for coverage on May 1 and completes the application on June 15. 
June 28 
Group mails in the application for new member on June 28. We will deny the coverage for this member since member did not apply for coverage within 31 days. Since the employee is a “Late Entrant” he or she cannot be added until your group’s next open enrollment period, unless he or she qualifies for a special enrollment period (described above) before that time. 
 
Whenever possible, do not wait for your group bill before notifying us of any additions, changes or cancellations. Early notification reduces the need for retroactive adjustments and the likelihood that the change will not be made as of the requested effective date. 
It is equally important that you let us know right away when an employee's eligibility ends. That employee's coverage should be cancelled, and should not continue to appear on the bill. If the employee (or covered dependents) enrolls in COBRA within the prescribed time frame, coverage will be reinstated retroactively.  
 
©2005-2014 copyright of Anthem Insurance Companies, Inc.

Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Com pany. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi"), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare"), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use of the Anthem Web sites constitutes your agreement with our Terms of Use