HEALTH PLAN DEPENDENT ENROLLMENT & DEPENDENT PREMIUMS
Page 25 of the SPD sets forth the requirements for enrolling dependents. There is a 30-day window from the time a Participant qualifies for insurance in which to enroll dependents. If the Participant does not enroll a dependent (or dependents) during this period, then the Participant must wait until the next Open Enrollment period to obtain coverage for their dependent(s).
ENROLLING DEPENDENTS
In order to enroll eligible dependents, a Participant must submit a completed dependent enrollment form to the Fund, along with the premium payment and all required documentation within 30 days of the date the Participant becomes eligible. If the Participant does not enroll his/her dependent(s) within this 30-day period, the Participant must wait until the next Open Enrollment period unless the Participant experiences a Life Event that provides a special enrollment opportunity to add dependents as described on the following page.
When a qualified Participant does not pay the dependent premium, the Health Plan will send a reminder letter. They will also attempt to reach the Participant by phone. If this fails, the dependent’s coverage will be terminated, and the Participant will not be able to insure their dependent(s) until the next Open Enrollment period. Despite these safeguards, failure to pay dependent premiums happens more times than anyone would like. Page 27 of the SPD sets forth an exception that Participants should keep in mind if they find themselves in this situation:
LATE PAYMENT EXCEPTION – “ONE-IN-THREE RULE”
If a Participant fails to pay the required dependent coverage premium by the due date, dependent coverage will be terminated. However; the Participant may make a request to reinstate dependent coverage based on the One-in-Three rule, described below:
A Participant may submit a written request to the Fund Office, asking that an exception be made to allow a late payment and reinstate dependent coverage. The written request must be received no later than 45 days from the first day of the calendar quarter for which payment was due. The Fund Office will grant the request and no subsequent late payment exceptions will be allowed for three years (36 months) from the date the initial exception was made.
What this means is that once every three years, the Health Plan will allow a late payment of the dependent premium. If you find yourself in a situation where you have missed the dependent premium payment deadline, you still have a chance to continue your Dependent’s coverage.