FAQs Applying for Insurance as an Employee

Employees who want to decline coverage may do so in Zenefits, but must be absolutely sure of their decision before choosing to decline. Those who choose decline coverage during initial enrollment will not be covered under their employer's insurance plans or pay any premium deductions. They can only enroll in coverage outside of their eligibility window during a company's open enrollment period or in the event of a qualifying life event.

Declining Coverage in Zenefits

If a benefits-eligible employee wishes to decline insurance coverage, they can do so in Zenefits by logging into their dashboard and clicking "I decline medical/dental/vision coverage" in the enrollment flow. In the last step of the enrollment process, they are required to sign a waiver confirming that they wish to waive coverage and provide a reason for declining.

The Eligibility Window

Employees can enroll or make changes to their enrollment any time up to 30 days after their projected effective date.

Making Changes Outside of Open Enrollment

Changes can only be made to insurance status if employees have undergone 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.

After having a qualifying life event, employees can enroll or make changes to their insurance within 30 days. Due to processing time, this must be done directly in Zenefits within 27 days of the event.

Employees who choose to decline one or more lines of coverage offered by a company for themselves or their dependents must sign a waiver and provide a reason for declining.

The waiver that the employee will be required to sign will overview what declining coverage means for themselves and their dependents, including:

  • Confirming that the only way to enroll themselves or a dependent prior to the company's next Open Enrollment period (up to 12 months) is through a qualifying life event.
  • References to pre-existing conditions in the waiver do not apply to anyone under 19 who is enrolled in an Affordable Care Act-compliant health plan.

These reasons directly affect the company's ability to qualify for insurance coverage (see Participation Rules for Carriers for more information), and should be accurately reported.

For each line of coverage declined (medical, dental, or vision), select a reason from the list of categories for existing coverage:

  • Covered by parent's plan
  • Covered by spouse's plan
  • ChampVA
  • CHIP
  • FEP/FEHB
  • Indian Health
  • Medicaid
  • Medicare
  • Tricare/ Champus
  • COBRA
  • Individual Off-Exchange
  • Individual On-Exchange
  • Other Insurance Coverage
  • Retirement Plan
  • Student
  • Association coverage
  • Canadian Provincial Health Care
  • Coverage through another employer
  • Religious 
  • My reason is not listed
  • Other Coverage, same employer

Not all employee-supplied reasons may be valid. To ensure that the reason for declining coverage is valid, select the "My reason is not listed" option only if no other provided reason is applicable. This will generate a text box for you to enter why you're declining coverage.

If you've selected your medical, dental, and vision plans as a new hire, but would like to change it, you can do so up to 30 days after your effective date. For example, if your effective date is 11/01/2017, you can make changes up to 11/30/2017. To make changes, you'll log in and click on the banner at the top of the screen that reads, "Change or review your benefits selections until November  30th, 2017 at 23:59 p.m. PST" in order to make any changes.

If an individual has both group coverage and Medicare, they will need to coordinate with the carrier directly to determine which policy will be considered their Primary and which policy will be considered their Secondary. This is called Coordination of Benefits, and will dictate how their providers will bill for services and which policy will process the claim first.

Employees with Medicare who are also signing up for coverage through Zenefits do not need to provide any Medicare information to Zenefits. However, they will have to provide this information to their health care provider, so the provider is aware that the employee has both primary and secondary coverage. This will ensure that their billing is accurate.

For more information, please click this link.

Enrolling in group coverage may also impact premium. If an employee is enrolled in group coverage and is considering enrolling in Medicare, they can reach out to Zenefits Support for clarity around how enrolling in Medicare may impact their insurance costs through their employer.

Medicare will not have information on an employee's group policy, so they will not be able to advise on the potential premium impact. This information can be confirmed with the group policy's insurance carrier directly.

Though insurance applications normally require a Social Security Number (SSN), other forms of identification are valid for certain individuals.

Employees

Social Security Numbers (SSNs) are required for employees enrolling in group health coverage through their company. In the event that they do not have an SSN (e.g., in the case of someone working in the US on a work visa or students on an F-1 Visa), they can use their Individual Tax ID Number (ITIN) instead. 

They may also be required to provide one of the following documents, at the carrier's discretion, to prove that they are legally living in the US:

  • Alien Registered Receipt Card with Photograph (INS Form 1-151 or -551).
  • US passport (updated or expired).
  • Certificate of US Citizenship (INS Form N-560 or N-561).
  • Certificate of Naturalization (INS Form N-550 or N-570).
  • Updated foreign passport with I-551 stamp pr INS Form I-94 indicating unexpired employment authorization.
  • Updated Temporary Resident Card (INS Form I-688).
  • Updated Employment Authorization Card (INS Form I-688A).
  • Updated Reentry Permit (INS Form 1-327).
  • Updated Refugee Travel Documents (INS Form I-571).
  • Updated Employment Authorization Document issued by the INS which contains a photograph (INS Form I-688B).

Dependents

If you would like to view additional information about enrolling dependents without SSNs, please see this page.

Employees have 30 days from their projected effective date to enroll in coverage.

  • If the employee enrolls in coverage on day 29 beyond their effective date, their coverage will be retroactive to their effective date. In other words, the first day of coverage is actually in the past.
    • For example, if an employee's effective date is 3/1 and the application isn't processed by the carrier until 3/15, the employee's coverage is retroactive to their original 3/1 effective date.
  • Employees can submit claims for any services received on or after their effective date.

Some employees prefer to maintain their existing coverage until after Zenefits confirms the new application is approved. This ensures that there is no lapse in your coverage as you transition from one plan to the next. Alternatively, some employees prefer to cancel their existing insurance prior to receiving approval of their new insurance in order to avoid paying dual premiums.

However, if you have existing coverage under a carrier and you're applying for new coverage with the same carrier (e.g., both your new and previous employers use the same insurance carrier), the carrier won't approve your new application until the old coverage is cancelled.

If you find yourself in this situation:

  1. Contact your previous employer’s HR department or the carrier itself to cancel coverage.
  2. Request that your existing coverage is cancelled after the effective date for your new plans.

Once this has been done, Zenefits can submit the application for approval.

When enrolling in insurance coverage due to a qualifying life event (QLE), documentation is needed to prove the date of the QLE. Proof documents are official documents directly related to the event.

For example:

The image must be clear and legible. Key dates must be included in the uploaded document.
For example:
  • Date of loss of coverage
  • Marriage date
  • Date of birth
If you have questions on what is considered acceptable documentation, please contact your broker.

Example of an acceptable document

The Certificate of Creditable Coverage (COCC) below is a good example of a loss of coverage document because it has the official insurance carrier logo at the top of the page and includes the name of the member to whom it applies as well as the coverage effective date and cancellation date.

image

Example of an unacceptable document

The document below is a medical insurance card and would not be accepted as it does not include the coverage effective date or cancellation date.

image

Inadmissible example document #2

The image below is a bad example of a loss of coverage document as none of the information is legible.

image

The insurance effective date is calculated based on your hire date and the waiting period set in place by your employer at the time of renewal. Effective dates cannot be changed for one employee. You can view your insurance effective date by clicking on the Medical, Dental, or Vision Insurance card from your Zenefits dashboard.

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For example, if your employer has a waiting period of "First of the Following Month" and your hire date is 10/23/2017, your insurance effective date will calculate to 11/01/2017.


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