PPM Section 14 - Insurance Plans: Health Insurance
PPM Section 14 - Insurance plans: health insurance
Health insurance
Policy and procedure are located in the Employee Handbook.
Enrollment upon hire
Policy and procedure are located in the Employee Handbook.
Enrollment at other times
Open enrollment period
Policy and procedure are located in the Employee Handbook.
Eligible dependents within 31 days of qualifying events
Employees may add eligible dependents to their coverage within 31 days of qualifying events. For each qualifying event, certain documentation must be provided, as follows: Marriage (marriage certificate); having a child by birth (birth certificate) or adoption (adoption placement paperwork); being appointed legal guardian of a child and ordered by a court to provide health insurance for the child (relevant legal papers and court orders); acquiring step-children through marriage (marriage certificate and copies of birth certificates or adoption paperwork for step-children); or, loss of your spouse's health insurance due to your spouse's death (copy of death certificate and birth certificates or adoption paperwork for any children covered under that plan). If your spouse loses health insurance due to an employment status change, HIPAA provisions may apply (see next item).
HIPAA provisions
Under certain circumstances, employees may be able to enroll in health insurance at other times under HIPAA provisions as outlined in the Employee Handbook.
Please contact Human Resources for detailed enrollment information and the appropriate forms.
Coverage for incapacitated children
Health insurance may be continued for certain incapacitated children beyond the date their
coverage would otherwise terminate due to attainment of the limiting age for dependent children,
provided the child is incapacitated prior to reaching the limiting age. Incapacitated children
are defined as children who are incapable of earning their own living because of physical
or mental handicaps, and who are solely dependent upon the employee for support.
To assure continuation of coverage, the employee must submit to Human Resources a written
statement from a health care provider verifying the child's incapacitation. This statement
must be submitted within thirty-one (31) days of the date of attainment of the limiting age
for dependent children.
Health insurance continuation
COBRA
COBRA policy is located in Employee Handbook.
Continuation during approved paid leave of absence
Coverage and premiums continue without interruption.
Continuation during an approved non-paid leave of absence
COBRA provisions apply. If an employee on an approved non-paid leave of absence returns to active payroll following the leave of absence, all group insurance, including health insurance, may be reinstated.
Continuation during Workers' Compensation leave of absence
See Workers' Compensation—Group Insurance.
Continuation during Family and Medical Leave of absence
See FMLA—Benefits and Seniority.
Continuation during layoff
See Reduction in Force—Group Health and Life Insurance.
Continuation during an unpaid disciplinary suspension
COBRA provisions apply.
Continuation at termination
COBRA provisions apply.
Continuation upon termination of active employment by death
The dependent survivor(s) of a deceased active employee is eligible to continue on WMU group
health insurance under which the employee was enrolled for one (1) year following his/her
death. The University will continue the same employer's share of premium costs as it contributed
at the time of the employee's death. The dependent survivor(s) will be billed for the deceased
employee's payroll-deducted share of the premium.
After the one (1) year period, the University-contributed share of premium costs will cease,
but eligible dependents (who meet the dependent eligibility standards of the health plan)
may remain under the health plan at the group insurance premium rate, provided both of the
following conditions have been met:
1. The deceased employee was at least fifty-five (55) years old.
2. The deceased employee had completed at least ten (10) years of full-time service to
the University at the time of death.
Human Resources will bill the spouse or eligible dependent(s) for the total prevailing
monthly group rate.
HIPAA privacy practices
HIPAA information is located in PPM Section 19-Health Insurance Portability and Accountability Act.