- Employee must complete the probationary waiting period, set by the employer (30-90 days is common); THEN coverage is effective on the 1st or the 15th of the following month.
- Employee completes and signs the application(s) for ALL lines of coverage (Medical, Dental, Life etc.)
- If the employee has dependents (spouse, domestic partner or children) he or she should either:
a) Include them on the application, or
b) Sign a waiver/ declination for those dependents. - Pre- Existing issue. If the employee has been uninsured for the prior 60 days, the member may have a pre-existing condition exclusion waiting period. This is true for PPO medical and most PPO Dental plans. The pre-existing issue does not usually apply to HMO’s.
- Late enrollee’s (late entrants) may be treated adversely:
- Dental: Enrollees may be subject to a 12 month waiting period for major services.
- Medical: Enrollees must wait for “Open enrollment” unless there is a “ *qualifying event”.
- HMO enrollees must choose a Primary Care Physician (PCP) or dentist. The PCP directs all care. To change PCP’s the member must call the insurance company directly (before the 15th of a month). The 1st of the upcoming month the member will be assigned to the new, contracting provider.
- Very Important!!! All employee applications must be submitted before the employee’s effective date to insure new coverage. Some insurance companies allow up to a 30 day grace period to receive all employee applications, however most insurers will not “backdate” coverage unless applications are received in their office prior to effective date.
- Review the application to make sure: employee has made plan selection, hire and effective dates are completed correctly according to employer requirements, all is accurate, legible and signed.
- Respect the law and the privacy of the employee by letting the employee know the employee is free to call us (your health and life agent) with any personal questions or concerns.
- Upon completion of the enrollment application(s) you may fax the application to the insurance company directly, you may fax the application(s) to us or you may email the applications to us for review and follow up with the insurance company. You must also audit your insurance invoices to confirm your monthly invoices reflect the recent changes. Most invoices take 30 days to reflect the change.
* Qualifying event for Off-anniversary Enrollments include: Marriage (to add spouse), birth or adoption (to add child), loss of spousal group coverage (to add all persons covered by spouse previously). Applications must be submitted within 30 days.
For more information call 619-668-5200 or email info@teaguefs.com.
