You can submit enrollment information through our secure site, paper or electronic data exchange (requires set up, may be subject to vendor approval).
Yes. A new employee who decides to waive coverage when initially eligible should complete an enrollment form and return it to Significa Benefit Services. A properly completed enrollment form (and signed waiver) must be on file if the employee wishes to enroll at a later date under "Special Enrollment" circumstances, and for government required reporting obligations.
Many plans do not permit enrollment outside the annual open enrollment period. If that is the case, the employee or dependent must wait until the plan's next open enrollment period to enroll. However, if the employee or dependent experiences a special enrollment event prior to the next open enrollment period, he/she may have an opportunity to enroll earlier. Contact a Client Services enrollment specialist if you have questions or need assistance.
Self-funded plans may use Significa Benefit Services' "Self-funded Group Enrollment Form" for all types of enrollments, including timely new hires, dependent enrollments, late enrollments, open enrollments, special enrollments and reinstatements. This form can be downloaded from the Significa Benefit Services website. See Self-funded Group Enrollment Form. Self-funded plans also have the option of enrolling new employees or changing current employee information online.
Newborn enrollment requirements vary by plan, but most plans require enrollment of newborns within 31 days of birth. Please consult the "Special Enrollment" provisions in your plan document for your plan's specific requirements.
Self-funded plans may use Significa Benefit Services "Self-Funded Group Enrollment Form" for all types of enrollments, including all dependent enrollments. This form can be downloaded or enrollment can be made from the Significa Benefit Services website. See S/F Enrollment Form.
Group health plans are required to provide special enrollment periods during which
individuals that previously declined coverage for themselves and their dependents may be
allowed to enroll. These circumstances include:
(1) Loss of eligibility for coverage under a group health plan or other health insurance coverage due to specific loss of eligibility events or when an employer terminates contributions toward health coverage;
(2) Acquisition of a new dependent through marriage, birth, adoption or placement for adoption;
(3) Loss of eligibility for coverage under Medicaid or the Children’s Health Insurance Program (CHIP); and
(4) Becoming eligible for a premium assistance subsidy under Medicaid or CHIP.
Along with a completed enrollment form, acceptable proof of the special enrollment event must be provided with the enrollment. For events 1 and 2 above, the submission must generally be received by Significa Benefit Services within 30 days (or any longer period that applies under the plan) of the special enrollment event. For events 3 and 4 above, the submission must generally be received by Significa Benefit Services within 60 days of the event.
Refer to the eligibility section of your plan or policy for a full description of special enrollment provisions or contact our Client Services Department with questions.
An Employee Change/Termination Form can be downloaded from our website and should be used to notify us of most status changes. Terminations can also be submitted online by the employer. Status changes include:
- Name and address changes
- Life insurance beneficiary changes (employee signature is required)
- Waivers of coverage (employee signature is required) Employees and/or dependents who are already on the plan and who now wish to discontinue their coverage must notify Significa Benefit Services.
- Employee status change (class, position, salary) If an employee's class, position or salary is used to determine the level of their benefits, notify Significa Benefit Services of the change. For example, disability income benefits and life insurance may be affected by a change in salary.
- FMLA Leave
- Terminations of coverage for any reason, including but not limited to:
- Termination of employment
- Reduced hours
- Approved leave of absence
- Child dependent ceases to satisfy age or other eligibility requirements
Notify Significa Benefit Services immediately upon termination.
An employee's or dependent's coverage will terminate when they cease to satisfy the eligibility requirements as set forth in the plan. Examples of this may include:
- Termination of active full-time employment for any reason
- Reduction of hours (full-time hours reduced to part-time)
- Child dependent reaches the maximum dependent age
- Divorce (applies to spouses and step-children of the employee)
- Employee does not return to full-time work after FMLA leave
Refer to the "Eligibility" section of your plan for a full description of termination events.
An employer that is subject to COBRA as defined by federal regulations must notify their
COBRA administrator within 30 days that an employee’s coverage has terminated.
If Significa Benefit Services is your COBRA administrator:
- Within 14 days of being notified by the employer that an employee’s coverage has terminated, Significa Benefit Services will mail a COBRA notice and election form to qualified beneficiaries.
- To elect COBRA, the qualified beneficiary must complete the election form and return it to Significa Benefit Services within 60 days.
- Upon receipt of the election form, Significa Benefit Services will mail the first premium invoice to the qualified beneficiary. The full initial payment must be received by Significa Benefit Services within 45 days.
- If the elected benefits are not administered by Significa Benefit Services, Significa Benefit Services will notify the employer of the election so that the employer can contact its insurance carriers.
- If the elected benefits are administered by Significa Benefit Services, the benefits will be reinstated when Significa Benefit Services receives the first full premium payment
Yes, at the time of initial enrollment and annually thereafter, Significa Benefit Services will request the domestic partner complete an Affidavit to confirm eligibility under the plan.
An employee can generally make a prospective change to his or her PPO elections at open enrollment or upon moving away from their current PPO's service area.
Your plan contains claims procedures. Those procedures give Significa Benefit Services a specified period of time to review and process a claim. Post service claims determinations must be issued within 30 days. Denials are required to be issued in writing. Many times, a denial is not a final determination.
To assure we properly and correctly process claims, we request information such as other coverage information, accident details or medical documentation in order to proceed with our evaluation and final determination of the claim. Most of these requests are issued on the Explanation of Benefits (EOB) and are sent to both the provider and employee.
A prompt response to these requests allows Significa Benefit Services to complete the claim process.
COBRA participants are invoiced monthly. Payment is due by the date listed on the invoice. A 30-day grace period is available, however, payments received after the grace period will not be accepted. This will result in termination of COBRA coverage.
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