Enrollment and termination rules are governed by North Carolina General Statute 135 Article B and protect members and provide consistency in administering the State Health Plan. Enrollment inconsistency and terminations can lead to retroactive premium adjustments, reconciliation issues and claims paid for members who are no longer eligible.
An eligible dependent of a covered employee includes:
Please remember that when employees add dependents to their benefit plan, they are asked to provide documentation of dependent eligibility under the State Health Plan. Check out this video (video is a demonstration with no sound) which demonstrates how HBRs review submitted documents in eBenefits.
Are any of your employees expecting? Click below for a resource to provide employees regarding how to add their newborns to Plan coverage.
During Open Enrollment, members can:
There will be no exceptions to this rule. Please remember, when employees enroll they are encouraged to print the confirmation page upon completion of enrollment. This rule emphasizes the importance of new hires enrolling in a timely manner and the consequences that will follow with failure to elect coverage within 30 days (possible gap in coverage, unable to enroll in the Plan until the next Open Enrollment period, etc.).