123-456-7890 [email protected]

Eligibility + Enrollment

Smith Smith & Jones offers several options to help select benefits that best suit your and your family’s needs. Consider factors such as spouse benefits, dependent eligibility and upcoming qualifying life events as you select your benefits for the plan year.

Eligibility

You are eligible for benefits if you are a regular, full-time employee. You may also enroll eligible dependents for benefit coverage. The cost to you for dependent coverage will vary depending on the number of dependents you enroll in the plan and the particular plan you choose. When covering dependents, you must select the same plans for your dependents as you select for yourself.

Eligible Employees…

All regular full-time employees working 30 hours per week or more are eligible to participate in the Smith Smith & Jones benefits program.

Eligible Dependents include:

  • Your legal spouse or qualified domestic partner
  • Children under the age of 26, regardless of student, dependency, or marital status
  • Children who are fully dependent on you for support due to a mental or physical disability, and who are indicated as such on your federal tax return, may continue coverage past age 26

Eligible Dependents…

Eligible employees may also choose to enroll eligible family members, including a legal spouse / state-registered domestic partner and/or children.

Children are considered eligible if they are:

  • You or your spouse’s / state-registered domestic partner’s biological children, stepchildren, adopted child or foster child up to age 26
  • You or your spouse’s / state-registered domestic partner’s children of any age if they are incapable of self-support due to a physical or mental disability

New Hires

For newly hired employees, coverage begins on the first of the month following 30 days of employment. (You must enroll within 30 days of becoming eligible).

When Coverage Begins

Your enrollment choices remain in effect for the benefits plan year, January 1, 2016 – December 31, 2016.

Dependent Verification

To control health care costs and meet health plan contract obligations, Smith Smith & Jones performs periodic reviews to verify family members’ eligibility for enrollment in the benefit plans. Smith Smith & Jones and the insurance carriers reserve the right to request documentation (for example, marriage and/or birth certificates) to verify eligibility.

Remember: If you have a qualifying event that impacts your benefits status, you must make changes within 31 days of the event. Evidence of the event is required.

Smith Smith & Jones Open Enrollment Begins November 9th, 2015!

Day(s)

:

Hour(s)

:

Minute(s)

:

Second(s)

What is annual open enrollment and why is it important?

Open Enrollment is the period of time each year when you can sign up for health insurance. If you don’t sign up for health insurance during this time, you probably won’t be allowed to sign up for health insurance until the next open enrollment period.

If you’re eligible and apply for health insurance during open enrollment, the health plan must insure you. It’s not allowed to use underwriting or require evidence of insurability, both of which could make it harder for you to get health insurance.

Enrolling in Your Benefits

Every year you will have an opportunity to make changes to your benefits and covered dependents during Open Enrollment. Outside of the annual Open Enrollment period, you must have a qualifying life event that satisfies federal regulations.

Qualified Life Events

Once you elect your benefit options, they remain in effect for the entire plan year until Open Enrollment time. You may only change coverage during the plan year if you have a Qualified Life Event, and you must do so within 30 days of the event.

Qualified Life Events include:

  • Marriage
  • Divorce or legal separation
  • Birth of your child
  • Death of your spouse or dependent child
  • Adoption of or placement for adoption of your child
  • Change of employment status by you or your spouse
  • A significant change in your or your spouse’s health coverage due to your spouse’s employment
  • Qualification by the Plan Administrator of a Medical Child Support Order

If you have a Qualifying Life Event and want to request a mid-year change, you must notify Human Resources and complete your election changes within 30 days following the event. Be prepared to provide documentation to support the Qualifying Life Event.

Making Changes to Your Benefits

Certain qualifying life events allow you to apply for a ‘Special enrollment period’ within which you can make changes to your coverage. Keep in mind that any change in coverage must be consistent with your change in status.

Examples of Qualifying Events

If one of the following qualifying events below occurs, you have 31 days from the date of the event to make adjustments to your benefits that are consistent with the event.

  • Marriage, legal separation or divorce
  • Birth or adoption of a child
  • Change in eligibility of a child
  • Death of a dependent family member
  • Change in your spouse’s / state registered domestic partner’s employment status
  • Your spouse / state registered domestic partner reaches age 65 and is covered by Medicare (Employees have 60 days from the date of enrollment in Medicare to make an adjustment to your benefits)
  • FMLA special requirements
  • HIPAA special enrollment rights

Your new coverage becomes effective on the date specified for the Annual Enrollment period or on your eligibility date or status change date.