FAQs Applying for Insurance as an Employee

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

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.

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

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.

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.

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.