Code of Massachusetts Regulations › 805 CMR - GROUP INSURANCE COMMISSION › Title 805 CMR 9.00 - ELIGIBILITY AND PARTICIPATION › Section 9.01 - New Employees

Current through Register 1525, July 5, 2024
(1) A new Employee's department or agency
			 head shall determine whether the Employee is eligible for Commission coverage.
			 Employees whose duties are Seasonal or Emergency Employment or of a duration of
			 not more than three months with no reasonable expectation of an extension, are
			 not eligible for Commission coverage. Department or agency heads who are unable
			 to determine eligibility shall send all information relating to the new
			 Employee's work to the Commission for a final and binding eligibility
			 determination. Employees who do not enroll in Commission coverage when they are
			 first eligible are presumed to have declined coverage and may later enroll
			 during the Commission's Annual Enrollment or with a qualifying event as
			 specified in the Commonwealth's Section 125 Cafeteria Plan. Once an Employee
			 enrolls in a health plan, the next opportunity to change plans is the GIC's
			 next Annual Enrollment period, except as otherwise required by law.
(2)
Reserve
.
(3)
Effective Date of Insurance
			 Coverage
. Eligible New Employees who apply for Commission benefits
			 within the new hire enrollment period shall be insured on the first day of the
			 month following the employees start date. If the start date is the first of the
			 month the employee shall be insured on that day.
The Commission benefits effective date for new hires cannot be
				changed. Employees will be responsible for payment of premiums for elected
				benefits from the effective date of coverage until payroll deductions can be
				initiated. Failure to pay the premiums will result in termination of
				coverage.
(4)
Retroactive Health Insurance Effective Date
. Employees
			 or dependents may request Commission Health Coverage to begin on the first day
			 of employment or the first day of the health coverage waiting period referenced
			 in 805 CMR
			 9.01(3), as applicable, if
			 all of the following conditions are met:
(a)
			 the Employee or Dependent is not enrolled in other health coverage and incurs
			 an unplanned and urgent medical expense that exceeds the Employee's full cost
			 monthly premium;
(b) the unplanned
			 and urgent medical expense occurs on or after the first day of employment or
			 waiting period but before the effective date of health coverage; and
(c) the Employee requests such coverage in
			 writing and provides satisfactory documentation of the unplanned and urgent
			 medical expense.
Coverage shall become effective as of State or Municipal
				Employees' first day of active employment, subject to their timely payment of
				the full-cost health insurance premium for the entire hiatus period. Coverage
				entitles the Employee only to those benefits that are otherwise available
				through the health plan selected, and claims may be denied in whole or in part,
				consistent with the health plan's covered benefits.
Employees' effective date of life insurance, if eligible, shall
				only become effective as described in
				805
				CMR 9.01(3)  or
				9.02.