CHP
Late Enrollment: Special Enrollment Eligibility |
| |
If
CHP coverage had previously been declined by the worker and/or
for any eligible dependents, CHP enrollment may be available
under the provisions of a special enrollment period. Application
for special enrollment must be received by Concordia Plan
Services within 30-days from the date the other coverage is
terminated. If the form is received after 30 days, workers
will not be eligible to be enrolled until the next “Open
Enrollment” period is held and coverage would be effective
the first of the next calendar year.
|
| |
| Special
Enrollment – Workers and/or their dependents,
who previously declined CHP coverage due to other coverage in
another health plan, may be eligible to enroll in the CHP at
a later date under the special enrollment provisions if they
are eligible for coverage and the
following conditions are met. An Application for Special Enrollment
in CHP must be received in the Concordia Plan Services office. |
| |
| State
reason for declining coverage – The worker must
provide a statement at the time coverage is declined indicating
the reason for declining coverage. To be eligible for special
enrollment, the worker must have declined coverage
due to coverage under another plan. Any breaks in coverage periods
must be less than 63 days. |
| |
| COBRA
coverage must be exhausted – If coverage was
declined for a worker and/or any dependent(s) because the other
coverage was COBRA continuation coverage, the COBRA continuation
coverage must be exhausted before the special enrollment will
be available. Any breaks in coverage periods must be less than
63 days. Requesting termination of COBRA continuation coverage
or non-payment of coverage is not a qualifying event. |
| |
| Loss
of other coverage – If the other coverage that
applied to the worker and/or any dependent(s) when enrollment
was declined was not COBRA continuation
coverage, then to be eligible for the special enrollment period,
the coverage must be lost due to a loss of eligibility for the
other coverage or the employer contributions toward the other
coverage must have ended. Loss of eligibility includes a loss
of coverage due to divorce, legal separation, death, termination
of employment, or reduction in hours of employment. Loss of
coverage does not include a loss due to failure of the participant
to pay premiums on a timely basis or termination of the other
coverage for cause. Any breaks in coverage periods must be less
than 63 days. |
| |
| Certification
– A certificate of prior coverage must be submitted
with the request for special enrollment. In the absence of a
certificate of prior coverage, the individual has the right
to demonstrate prior coverage by (1) attesting to such coverage,
(2) providing corroborating evidence (e.g., a doctor’s
bill or pay stub showing payroll deduction), and
(3) cooperating with the plan to demonstrate coverage. If
an individual does these three things, it will be the same as
presenting a certificate. |
| |
| If
you have specific questions regarding special enrollment eligibility,
please contact our office at 888-927-7526 or send an email to
info@ConcordiaPlans.org |
