Benefits Enrollment Question

mzihc · October 2009

Located in <?xml:namespace prefix = st1 ns = "urn:schemas-microsoft-com:office:smarttags" />California, with corporate office in Florida. 3-4 employees in Fl, the rest in California. Total size : less than 50.<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />

Our handbook describes a full time employees as “Regular Full-time Employees are normally scheduled to work 40 hours per week.”

To date we have offered all full time employees benefits upon hire – no waiting or probationary period.

Our corporate office doesn’t always share information with CA in a timely manner. They hired a receptionist full time about 3 months ago and we didn’t even know for 1 month or two.

Last week I rec’d an email asking that I send the receptionist our benefit information as “she had passed her 90 day probationary period.”

We haven’t had a probationary period for any other employee and she was hired on 3 months ago – not a temp.

I sent the receptionist all the appropriate paperwork but....

Our healthplan (I didn’t get into vision or dental its similar) is set up with a 0 day waiting period. Enrollment is supposed to occur during the month of hire, effective the month following hire. (EX. Hired Jan 15, eligible for Feb 1 effective date)

Somebody help me here – if her hire date was, say Aug 1, I understand the only time I would have been able to enroll her would have been between Aug 1 – 31, and now she is no longer eligible and will have to wait until open enrollment (which for us is next July.)

Correct? Incorrect? Comments?

vikingcohr · November 2009

It's an error on the company's part. The employee shouldn't have to wait until open enrollment. Notify the insurance company that her benefits are retroactive to the proper date.

mzihc · November 2009

I know that I do need to contact the HP to discuss but going to check with you folks anyway - is this something that the HPs would normally allow us to do ? Admit we should have enrolled 4 months ago and add her? Everytime I've dealt with them or the broker its seems as they are pretty solidly set on their enrollment dates - I can slide a week or so into the next month and still get it retro'd back but I've never tried this far. I've had them call me to verify employment dates to check eligibility when enrolling a new person.

6274086 · November 2009

We used to have the same problem. If it is a common occurence the insurance carrier will probably not budge. Ask if you can do a promise to pay letter and get an exception. We had to change our waiting period at renewal to 60 days and start coordinating with payroll to track new employees when the location were not properly notifiying us. Unfortuneately, I have had occasions where i have had to fudge the date of hire and enroll them current and then refund them any deductions (or pay for the medical bills they incurred). Definately a last resort.

LHSsoccer13 · November 2009

I understand from talking with other HR professionals that if they forget to include someone in their enrollment, or if they were unaware of a new employee that they too have fudged the start date. I don't think that it is an uncommon practice. However, I would be very careful with this type of work. While it is probably a long shot, when (if) you provide a census near the end of the year to get competitve quotes you might be providing the carrier with the correct start date and they will have something different in their system.

Also, falsifying documents to insurance companies can cause the carrier to drop the group immediately, leaving the entire organization without coverage.

Just some food for thought.

mzihc · November 2009

I was wondering how other orgs handled it. The 'fudging' was a consideration but I was not comfortable doing that for a variety of reasons, including those you list. I've basically decided to toss it back to corporate to handle and don't expect to be included in how its handled.