Special Enrollment Period and Relaxed Eligibility Requirements

April 16, 2020

We previously communicated about options that may be available to groups to help group members who may need coverage support due to COVID-19. We want to remind you about the relaxed eligibility requirements and optional special enrollment period.

Eligibility Requirements
We have relaxed the eligibility requirements for currently enrolled/covered group members.   

  • From now through April 30, employers can maintain employees who were enrolled on their plans as of March 20, regardless of the eligibility definition stated in their plan or the BPA. 
  • This includes reduced work hours, furlough, leave of absence or layoffs.
  • Groups do not need to do anything. No paperwork or email is needed, as we will accept current and accurate eligibility files.
  • This flexibility does NOT apply to those who are newly electing coverage via the special enrollment period (see below).

Special Enrollment Period
We are also offering groups (ASO and fully insured) an optional special enrollment period from March 30 through April 30. This would apply to eligible employees and their dependents who previously declined coverage and now want to enroll, or currently enrolled employees who wish to add an eligible spouse or dependent on their existing coverage.

  • Applicable enrollment changes must be received on or before Friday, May 1. 
  • Effective date of coverage will be the group’s standard coverage effective date/billing date (in April) – for most groups this will be April 1.
  • This enrollment event will be for medical/pharmacy and dental coverage only.

Employers do not need to notify their account representative if they plan to use this special enrollment option. Employers can continue to use the standard eligibility process for their market segment to add employees.