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 1531, September 27, 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:
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.
(5) Employer Notification to New Employee. The Employee's department or agency head or Group Insurance Coordinator shall inform newly hired employees of their eligibility for Commission coverage, the benefits that are available to them, and the application deadline. The Group Insurance Coordinator shall also notify newly hired employees that premium deductions for Commission coverage are taken one month in advance of coverage or that the Employee will be billed for missed premiums. The Group Insurance Coordinator shall also provide information to the employee about Consolidated Omnibus Budget Reconciliation Act (COBRA) continuation coverage.
(6) New Employees' Duty to Notify Employer. Eligible Employees who are advised by their department or agency head that they are eligible for Commission coverage shall, inform their employer whether they intend to enroll in Commission coverage. Those enrolling in Commission coverage shall promptly select coverage and complete all necessary forms or make coverage elections through the GIC Member Portal. Persons who fail to enroll in Commission coverage when first eligible may do so during the next Annual Enrollment period or with a qualifying event as specified in the Commonwealth's Section 125 Cafeteria Plan.
(7) Premium payment for Commission coverage must be made one month in advance of coverage in order for coverage to become effective. For new hires, employees may be billed for the period of coverage prior to the start of payroll deductions. Failure to pay the billed premiums will result in coverage termination. The employee can enroll during the next annual enrollment or with a qualifying event as specified in the Commonwealth's Section 125 Cafeteria Plan.
(8) As a condition of employment, employees shall provide information to the Commonwealth as required by law including, but not limited to, disclosures required by the Health Care Reform Act and the Affordable Care Act.
(9) If an employee is requesting a coverage effective date change to a different month, the employee's effective date of coverage shall be determined by the Commission, and is subject to receipt of premium before coverage becomes effective.
(10) Recalled Employees who do not continue their coverage with the Commission during the period when they are laid off shall be treated as reemployed persons, consistent with 805 CMR 9.19.
