Special Enrollment Periods are provided when qualifying events occur and allow eligible participants and dependents to enroll or request changes to plan elections outside of Open Enrollment Periods. Enrollment and changes requested within a Special Enrollment Period must be completed within 31 days of the qualifying event and may require supporting documentation. If enrollment or changes are not completed within 31 days of the qualifying event, the enrollment or plan election changes may not be made until the next Open Enrollment Period.
Qualifying Events Supporting Enrollment:
Marriage - A new eligible dependent acquired through marriage must be enrolled within 31 days of date of marriage. Coverage will be effective as of the date of marriage. Required Documentation: Enrollment form. Additional documentation of marriage date may also be required (i.e. marriage certificate).
Birth - An enrollment form must be submitted within 31 days of the child's date of birth. Arrangements must be made to pay any applicable premium. Any applicable premium will be calculated from the child's date of birth. Required Documentation: Enrollment form. Additional documentation of birthdate may also be required.
NOTE: Upon birth, Aetna may route temporary identification cards that list newborn dependents. These temporary cards are provided to reflect 31 days of mandated newborn coverage. Regardless of receipt of temporary identification cards, a formal enrollment application adding a newborn must be submitted to the plan within 31 days of birth if coverage is desired beyond the 31 days of mandated newborn coverage.
Adoption or Placement for Adoption - New eligible dependent(s) acquired through adoption or placement for adoption must be enrolled within 31 days of adoption or placement for adoption. Coverage will be effective as of the date of adoption or placement for adoption. Required Documentation: Enrollment form. Additional documentation of adoption date may also be required.
Loss of Other Coverage - If an eligible participant or dependent were covered under another group health plan (including COBRA continuation) or had other medical insurance coverage when enrollment was declined, and has lost or will lose coverage under the other plan as a result of loss of eligibility (due to such reasons as death of a spouse, divorce, legal separation, termination of employment or reduction in the number of hours of employment or, cessation of the employer's contributions to such coverage) or exhaustion of COBRA continuation coverage, eligible participants and dependents must be enrolled within 31 days from the loss of other coverage. Coverage will be effective as of the date coverage was lost. Required Documentation: Enrollment form. Additional documentation of divorce, death of spouse or legal separation date or HIPAA certificate/letter from former plan may also be required.
Qualified Medical Child Support Orders - Eligible participants and dependent(s) may be enrolled in accordance with the terms of the order. Required Documentation: Enrollment form. Additional documentation of court order may also be required.
Qualifying Events Supporting Termination:
New Coverage Due to Employment Status Change - If a Covered Individual enrolls in another group or individual plan as the result of a significant change in Covered Individual, guardian/parent or spouse employment status including commencement of employment, return from leave of absence or changes from part-time to full-time status or change in enrollment status at an academic institution, the Covered Individual may request a termination of his or her coverage under the Plan prior to the expiration of the current Benefit Period. To request an early termination of coverage, written documentation supporting the change in status and related new coverage effective dates must be submitted to the Plan Administrator within 31 days of the change in status. If accepted by the Plan Administrator, coverage will terminate on the effective date of the new coverage. Required Documentation: Written request to terminate coverage. Additional documentation such as HIPAA certificate/letter from insurance carrier or employer that confirms your name and the effective date of new coverage may also be required.
Page Updated: 05/08/15