California Small Group - Late Enrollees

[insurehound]

Anyone who works with Small Group in California hear of a State law indicating that late enrollees can come on to a Group Health plan pretty much at any time?

I always thought the late enrollees have only 30 days to enroll after they become effective, otherwise they need to wait until open enrollment. Unless there is a qualifying event.

Both Aetna and Anthem has told me that unlike other states and what their underwriting guidelines state, late enrollees can come on board at any time. The only issue is that the late enrollee will not be able to have a retroactive effective date back to the original hire date.

 

[DS4]

What?
I write small group with Anthem in California, other than the anniv renewal, the only other time a late enrollee can come on is if a HIPAA event situation happens,

This is from DOL web site,

What events trigger a special enrollment opportunity?
When the employee or dependent of an employee loses other health coverage, a special enrollment opportunity in the group health plan may be triggered. To have a special enrollment opportunity in this situation, the employee or dependent must have had other health coverage when coverage under the group health plan was previously declined. If the other coverage was COBRA continuation coverage, special enrollment can be requested only after the COBRA continuation coverage is exhausted. If the other coverage was not COBRA continuation coverage, special enrollment can be requested when the individual loses eligibility for the other coverage.
In addition, a special enrollment opportunity may be triggered when a person becomes a new dependent through marriage, birth, adoption or placement for adoption.
For each triggering event, a special enrollee may not be treated as a late enrollee. Therefore, the maximum preexisting condition exclusion period may be applied to a special enrollee is 12 months, and the 12 months are reduced by the special enrollee's prior creditable coverage. In addition, a newborn, adopted child or child placed for adoption cannot be subject to a preexisting condition exclusion period if the child is enrolled within 30 days of birth, adoption or placement for adoption and has no subsequent significant break in coverage.

 

[insurehound]

I know, that's how I know it but when I talked with Anthem and Aetna, there is something about our State that says differently. I can't seem to get a straight answer.

DS4, would you call Aetna and/or Anthem and ask??? I would be curious to hear what you are told.

I spoke to Aetna last week,. The Customer Service person asked me what State the business was in. When I told him California, he said that we are the ONLY State that allows late enrollees to come on after the 30 days from being eligible.

 

[DS4]

DS4, would you call Aetna and/or Anthem and ask??? I would be curious to hear what you are told.

Why don't you just call back and ask a different CSR the same question?
I would never in my right mind call an insurance company and ask a CSR any kind of a technical question. 99.9% of the time, I know more than the person I would be asking the question to. You might as well take a straw poll. Most of these people were working at Dairy Queen, McDonalds, etc 2 weeks earlier and now they have graduated from CSR academy.

 

[Dave020]

I "obtained" a group last year where one spouse waived coverage during open enrollment. Couple of months later wanted on the plan with no special enrollment circumstances (i.e., loss of other qualifying coverage). Anthem flat out stated she has to wait until next open enrollment to get on.

 

[insurehound]

Thanks for the tip and help DS4.

 

[insurehound]

I have asked several reps from two companies...I have my answer...

 

[VolAgent]

I have asked several reps from two companies...I have my answer...

And the answer is?

 

[insurehound]

According to DS4, no one at the CSR level knows anything. BTW, thanks for the help DS4 (I'm being sarcastic). That may or may not be true but I have called four different reps. and two different insurance companies AND have a call into a a supervisor. From what I can tell, yes, California does have legislation that allows late enrollees to come aboard after the 30 day grace period.

Personally, I have never had any problems getting the answers I need from CSRs so I am good. The rest of you can take it for whatever it's worth.

...and if anyone wants to actually be of any help, you can call whomever your contacts are to see if the story is the same.

...what I tell my clients is a different story

 

[DS4]

.... California does have legislation that allows late enrollees to come aboard after the 30 day grace period.

Have them cite the number of the Assembly Bill or Senate Bill. I tend to believe what I see more than what I hear.

Ok. I decided to waste 15 minutes of my day. I called Blue Shield of California Group Broker services. I also called Anthem Blue Cross Group Sales Support. I asked the question, " other than a HIPAA qualifying event, and, the anniversary date, is there any other time a late enrollee can be added?"
The answer was no.