When Does Coverage Begin and When Does It End?
- When Health Coverage Begins
- New Employees
- Rehired Employees
- Employees Returning from Leave Without Pay or Layoff
- New Dependents
- Employees Moving from a Nonparticipating Unit
- When Health Coverage Ends
- Employees on Leave Without Pay or Layoff
- Employees Who Terminate Employment
- Dependents
- Employees Moving to a Nonparticipating Unit
- Failure to Pay the Required Premium
When Health Coverage Begins
New Employees
If you are a permanent or long-term nonpermanent full-time or full-time seasonal employee, you and your eligible dependents are covered on the 31st consecutive day you are at work in pay status. For example, if you begin work on October 1, you are covered on October 31, assuming you have no periods of leave without pay or do not terminate your employment during that time.
If you are a permanent or long-term nonpermanent part-time or part-time seasonal employee who elects coverage during the first 30 days of employment, you and your eligible dependents are covered on the 31st consecutive day you are at work in pay status.
If you have leave without pay during your first 30 days of employment, you are covered after you return to work and are in pay status for 31 consecutive days. For example, if you start work on October 1, but have leave without pay and return to work October 15, coverage begins on November 14.
If you are disabled and not at work on the date coverage should begin, you are not covered for health benefits until you return. In this case, your dependents are eligible for benefits on the effective date even if you are not, unless they are confined in a hospital or similar institution on the date coverage would normally take effect. In that case, coverage is delayed until they are released.
Rehired Employees
If you were previously insured under this health plan as an actively working employee and you are rehired within seven calendar days of the date your insurance terminated, your coverage begins on the day you return. For example, if your coverage ends July 31 and you return to work on or before August 7, you are covered the day you return to work. If you were previously insured and you are rehired more than seven calendar days after your insurance terminated, you are considered a new employee and coverage for you and your dependents begins on the 31st consecutive day as specified for new employees.
If you are disabled and not at work on the date coverage should begin, you are not covered for health benefits until you return to work. In this case, your dependents are eligible for benefits on the effective date even if you are not, unless they are confined in a hospital or similar institution on the date coverage would normally take effect. In that case, coverage is delayed until they are released.
Employees Returning from Leave Without Pay or Layoff
If you were covered when you began leave without pay or layoff, when you return to work from leave without pay or layoff, you are covered starting the day you begin work. For example, if you return to work from leave without pay on July 15, coverage begins that day. Your dependents are eligible at the same time, unless they are confined in a hospital or similar institution on the date coverage would normally take effect. In that case, coverage is delayed until they are released.
New Dependents
If you add new dependents, they are eligible for benefits immediately unless they are confined in a hospital or a similar institution (except for newborn natural children). Coverage then begins when they are released from the facility.
Employees Moving from a Nonparticipating Unit
Employees who move from a bargaining unit which does not participate in the State Health plan to a bargaining unit that participates in Select Benefits will be covered on the first day of the month after the bargaining unit change occurs. For example, if your bargaining unit change is effective October 15, your health benefits change on November 1. If the change is effective on the first of the month, health benefits also change on that day. For example, if your bargaining unit change is effective November 1, your health benefits change on that day. If you are not in pay status at the time the change occurs, you will not be covered until the day you return to pay status. If you or one of your dependents are hospitalized on the date coverage changes, the new coverage will start when you or your dependents are discharged.
When Health Coverage Ends
Coverage under Select Benefits, including health coverage, ends at the earliest time that one of the following occurs:
Employees on Leave Without Pay or Layoff
Coverage ends on the last day of the month in which you were last in pay status. For example, if you worked or were on paid leave status on January 15 and then placed on leave without pay or layoff, coverage ends on January 31.
Employees Who Terminate Employment
Coverage ends on the last day of the month in which you last worked. For example, if you last worked on January 15 and terminated your employment, coverage ends on January 31.
Dependents
Coverage for a dependent (under benefit options that cover dependents) ends on the same day as the employee’s coverage, unless:
- you divorce. Coverage for your spouse ends on the date the divorce is final; or
- your child no longer meets all eligibility requirements (see pages 4 and 5). Coverage ends on the last day of the month in which the child first fails to meet any of these requirements.
Employees Moving to a Nonparticipating Unit
Health coverage ends on the last day of the month in which you move from a position which participates in Select Benefits to a position that does not. Other benefits are unaffected by this change.
Failure to Pay the Required Premium
Coverage terminates at the end of the month for which the last required premium was paid.
Reference: s_bw.pdf (Select Benefits Employee Booklet p10-11)