Insurance Plans: Health Insurance

Policies and Procedures Manual Section 14

The Western Michigan University health insurance policy and procedure are located at Insurance Plans, Employee Handbook Section 12.

Enrollment upon hire

Policy and procedure are located at Insurance Plans, Employee Handbook Section 12.

Enrollment at other times

1. Open enrollment period. Policy and procedure are located at Insurance Plans, Employee Handbook Section 12.

2. 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, Health Insurance Portability and Accountability Act provisions may apply (see next item).
3. Health Insurance Portability and Accountability Act 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 31 days of the date of attainment of the limiting age for dependent children.

Health insurance continuation under the Consolidated Omnibus Budget Reconciliation Act

1. COBRA. Policy is located at Insurance Plans, Employee Handbook Section 12.
2. Continuation during approved paid leave of absence. Coverage and premiums continue without interruption.
3. 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.
4. Continuation during workers' compensation leave of absence. See Employee Safety, Policies and Procedures Manual Section 12.
5. Continuation during family and medical leave of absence. See Leaves and Absences from Work: Family and Medical Leave of Absence, Policies and Procedures Manual Section 13.
6. Continuation during layoff. See Reduction in Force: Benefits, Policies and Procedures Manual Section 11.
7. Continuation during an unpaid disciplinary suspension. COBRA provisions apply.
8. Continuation at termination. COBRA provisions apply.
9. 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 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 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 55 years old.
   2. The deceased employee had completed at least 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

Please see HIPAA Privacy, Security and Breach Notification or Health Insurance Portability and Accountability Act.

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