FAQs About Enrolling in Coverage

Employees are eligible to enroll or make changes (such as adding/removing dependents or changing plans) to their medical, dental, or vision insurance at these three times:

  • during initial enrollment (as a new hire)
  • during open enrollment (the employer is renewing the company's plan)
  • after experiencing a qualifying life event (QLE)

If you have existing coverage and did not enroll your dependents already, you'll need to wait for your company's open enrollment period, or for a QLE. If you've recently experienced a QLE (e.g., you just had a baby), you can enroll your dependent by following these instructions.

Making Changes Outside of Open Enrollment

Outside of Open Enrollment, an existing employee (one who is not a new hire) can only make changes to their insurance status if they have experienced a qualifying life event (QLE). Examples of qualifying life events include getting married, giving birth, adopting a child, or a change in your spouse's insurance coverage status.

If you have missed your enrollment deadline or have questions about when your next Open Enrollment will be held, please contact your company administrator or internal HR department.

It is not possible to enroll dependents in a line of coverage or plan that the employee is not enrolled in. The employee must be enrolled in a line of coverage in order to enroll dependents in the same coverage and plan.

If you're a new parent who needs to enroll a newborn within 27 days of their birth (a qualifying life event), you don't need to provide an SSN when adding your newborn to your existing coverage. Newborns often don't receive an SSN until several weeks after their birth, but must be enrolled as a dependent within 27  days of birth.

If you're adding a dependent during your initial or open enrollment period (and not through a QLE), you will need to provide:

  • the dependent's SSN* 
  • US resident address. See this page if your dependents are not US residents.
  • Date of birth
*If your dependent does not have an SSN, you can leave this field blank during enrollment. Once they have received a valid one, update in Zenefits, then let your broker know so they can update the carrier. If your dependent doesn't have a valid SSN for visa purposes, contact your broker or insurance carrier to determine whether or not they are able to enroll.

Zenefits uses your home address to determine whether you're able to enroll in a particular plan. If you're moving during your enrollment, there's a chance that you may not be able to choose certain plans.

  • You can enroll in a PPO or POS plan no matter which state you live in, and you can keep the coverage when you move.
  • You can enroll in an HMO or EPO only if you live in the service area (e.g., state) covered by the plan.
    • For example, if you're moving to a new state, you won't be able to choose an HMO or EPO in that state until you update your address in Zenefits.
    • If you enroll in an HMO or EPO and then move out of the plan's area, you can change your plan in Zenefits by clicking on the Medical card, then Make Changes.

Follow these instructions to update the date of birth, Social Security Number, and other information for the dependents you've enrolled on your insurance coverage.

  1. Click on the Medical, Dental, or Vision Insurance app from the Zenefits dashboard.
  2. Select Edit Dependent Details link on the right side of the screen.
  3. Click Edit next to the dependent's name.
  4. Update the information and Save.

To update this information with your insurance carriers, reach out to them using the contact information on your member ID Card. If you are unsure of their contact information, please contact your Insurance Broker. Your broker's contact information is listed on your Zenefits account.

During open enrollment, you can see how much it would cost to add your dependents on the plan selection page. Simply check the box next to the person's name you wish to add to that line of coverage, and the cost estimate for each plan will be updated.

If you are outside of open enrollment, the only way to add dependents is through a qualifying life event. If you are within 28 days of a qualifying life event, you can view a cost estimate before enrolling a dependent in the qualifying life event flow.

If you want to decline coverage, you will need to log in to your Zenefits account and verify your information before declining the plans your company offers. Once your information is verified, you can decline coverage by clicking the links at the bottom of the page stating your desire to decline coverage. You will need to complete the rest of the enrollment to generate the decline waiver.

When an employee undergoes a qualifying life event (QLE), they can cancel their health plan by going through the QLE flow in Zenefits.

If you experience a QLE, you can decline coverage by following these steps: 

  1. Log into the Zenefits dashboard.
  2. Go to the Medical, Dental, or Vision Insurance app. 
  3. Click on the Make Changes button.
  4. You'll need to input your qualifying life event and select the date the QLE occured.
  5. Click Cancel my coverage.
  6. Input a reason for your insurance cancellation request and select the lines of coverage you wish to cancel. 
  7. Select the lines of coverage you would like to cancel.
  8. Click Cancel Coverage.
Keep in mind that you will not be able to enroll in insurance until the next open enrollment unless you experience another qualifying life event.

Note: Some health insurance carriers will not approve your cancellation request without additional documentation to prove that you experienced the qualifying life event you selected. If it's necessary for you to provide documentation, your broker will follow up with you. 

Some carriers offer packages of medical plans that are bundled together with dental and/or vision plans. Employees who choose to enroll in a bundled medical plan must also enroll in the associated dental and/or vision plans.

  • Bundled plans combine lines of coverage with the same carrier.
  • Enrollment in one line of coverage in a bundled plan includes enrollment in all lines of coverage bundled with that plan.
  • The carrier decides the specific plans for each line of coverage that is bundled together. Employees cannot pick and choose individual plans for each line of bundled coverage.
  • Employees cannot decline an individual plan within bundled coverage. Enrollment in bundled coverage is "all or nothing"; the entire bundle must be declined.

You can enroll your children as dependents on your medical, dental, or vision insurance plan at three (3) different times: during Initial Enrollment (as a new hire), during Open Enrollment (when your employer renews an existing plan), or due to a qualifying life event (QLE).

If you have existing coverage and did not enroll your child already, you'll need to wait for your company's Open Enrollment period, or for a QLE. If you've experienced a QLE, such as having a baby, you can enroll that child within 27 days of the event by following these instructions.

One of the steps in the enrollment flow in Zenefits asks the enrollee to specify if they smoke or are disabled. This information is included on insurance applications to determine how claims are paid out.

It is up to you to decide how you want to answer these questions, and Zenefits employees will not be able to tell you what you should or should not select. However, the disability question pertains to a) whether or not the employee claims as disabled in their taxes and b) receives disability benefits.

If a worker is transferring from one company to another company within Zenefits, and both companies share the same insurance policy, please contact our Customer Care Team and we will be happy to complete this for you. Zenefits will transfer the worker's benefit information from the original company to the new company with an effective date that aligns with the employment transfer date.
Note: If the companies share an insurance policy, but there are billing groups set up for the individual companies on that policy, Zenefits can transfer the benefits for you, but the broker will need to be contacted to ensure the billing group associated with the worker has been updated with the carrier.

If you're transferring a worker to a linked company that does not share the same insurance policy, the individual will need to be terminated and removed from insurance under the old company profile and enrolled as a new hire under the new company. If you have questions regarding waiving the new hire waiting period under the new employer policy, reach out to your insurance broker for questions and assistance.

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