Every year during open enrollment, employees may elect benefit coverage for the upcoming year. Once enrolled, a member cannot change their election unless they have a qualifying event. A qualifying event results in a special enrollment period (SEP). If an employee does not have a qualifying event, the employee is not eligible to enroll until the employer groups' open enrollment period.
Qualifying events:
- Marriage
- Divorce
- Death
- Birth or adoption of a child
- Dependent reaches the age limit under the plan (typically age 26 for children and age 18 for legal guardianship – with exceptions based on legal documentation)
- Change to/from part-time to full-time employment.
What changes are allowed?
If an employee has a qualifying event, the change in their coverage and to your employer plan must be made in accordance with our guidelines. BCBSND should be notified within:
- 31 days of the event for employer group plans
- The only event exception is the loss of Medicaid coverage.
These events do not result in a special enrollment period:
- Address Change
- Name Change
- Filing for Divorce (Divorce needs to be finalized before coverage can be changed)
- Court order for coverage of ex-spouse after divorce
- Loss of Coverage due to non-payment
- Loss of Coverage that is not considered minimum essential coverage
- Voluntary Loss of Coverage/ By request
Employees still need to notify BCBSND of non-qualifying events. Refer to our full enrollment guidelines for details and deadlines.
This information is a limited outline referring to health insurance guidelines only. Dental and vision guidelines can be found on the dental and vision enrollment guideline document. Refer to your benefit booklet for additional information. Contact your BCBSND representative with any questions.
