Who Is An Eligible Subscriber?

• Permanent and temporary employees working an average of 20 hours a week or greater
• Teachers throughout the calendar year
• Elected officials "may" be eligible
• Retired employees & their spouses

Who Is an Eligible Dependent?

• Spouse
• Divorced spouse: provided divorce decree does not explicitly state subscriber does not have to insure. In the event of divorce, the former spouse may maintain coverage only until the employee is no longer required by the decree to provide coverage or until either the employee or the former spouse remarries, whichever comes first
• Unmarried Dependent Children under age 19
• Unmarried Student Dependent under age 26
• Unmarried Disabled Dependent pursuant to certification approval by BCBS
• Child of a covered unmarried dependent

When Can an Employee Enroll?

• Date of Hire or upon completion of any probationary period set by your Community
• Open Enrollment
• Date of a Qualifying Event

What Constitutes a Qualifying Event?

• An Employee involuntarily loses eligibility for coverage under another group plan
• Date the employee voluntarily canceled coverage under another health plan due to the total termination of an employer’s contribution
• Date the employee qualifies as full time (20 hrs set by 32B Sect. 2)

What Does Not Constitute a Qualifying Event?

• Voluntary cancellation of current health/dental plan
• Electing to terminate one’s COBRA plan
• PCP/dentist no longer participating with current plan
• Change in spouse’s employer plans
• Change in contribution amount/premium by spouse’s employer
• Infertility treatment begun under another carrier and not covered
• A child’s first tooth

When Can A Dependent Enroll?

• Open enrollment
• Date of marriage
• Date of birth/adoption/legal guardianship
• Date dependent involuntarily lost eligibility for coverage under another health/dental plan
• Date dependent voluntarily canceled coverage under another health/dental plan due to the total termination of an employer’s contribution

What To Do When An Employee or Spouse Turns 65?

• Determine Status- Retired or still working (TEFRA)
• Determine Medicare Eligibility
• If TEFRA: subscriber and spouse should still enroll in Medicare Part A
• Has your community adopted Section 18 of Mass General Laws?
• If Retired and Medicare Eligible: subscriber and spouse should enroll in Parts A & B and transfer to a supplement plan

Application Guidelines

• The Requested Effective Date must be the date of the Qualifying Event
• Applications must be received within sixty days of the requested effective date
• Applications received after the sixty-day requirement must be reviewed and determined by Blue Cross Blue Shield Underwriting
• Applications for qualifying events must be accompanied by supporting documentation which must include the reason application was late

When To Include Supporting Documentation?

• Application is a result of a Qualifying Event
  • Marriage/birth/divorce/adoption - attach marriage/birth certificate or divorce decree
  • Loss of coverage elsewhere - letter from previous employer with date & reason coverage ends
• Employee has student dependents - student certification
• Employee and/or spouse is over age 65 - Medicare card or letter from Social Security
• Employee has family members with different last names - birth/marriage certificate

Minimum Required Application Information

• Employer signature and date
• Date of birth and gender for each family member
• Employee’s Social Security Number
• Primary Care Physicians for employees selecting Managed Care Products (HMO Blue, Blue Choice, Managed Blue for Seniors, etc.) No claims will be paid by BCBS and no referrals will be authorized until a PCP is listed.
• Group Number

How To Avoid a Phone Call from the MIIA Enrollment Staff

• Your Community Name
• Your Signature & Date
• Your Group Numbers
• Requested Effective Date
• Date of Hire
• Type of Transaction - Add/Change/Cancel & cancel code
• Remarks explaining application
• Product Info: Plan type, Individual/Family, Medical/Dental
• Medicare Information - photocopy of Medicare card
• Supporting Documentation

Plan Types

MIIA offers the following plan types:

• Health Maintenance Organizations
• Point of Service Plans (POS)
• Preferred Provider Organizations (PPOs)
• Indemnity Plans
• Dental Products
• Senior Plans
• Medicare HMO Blue

Medicare HMO Blue Enrollment Highlights:

• Must be retired
• Must be enrolled in Medicare Parts A & B
• Must reside within the service area
• Must select a Primary Care Physician
• Can only enroll when initial eligibility begins or January 1st of each calendar year

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