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Broker's Guide

BCBSRI Group Enrollment Guidelines

The following is to assist you in maintaining membership records for your group. If you have any questions, please call your Membership Administration Representative at the number listed on your billing statement. These guidelines will change from time to time to comply with changes in laws or regulations.

Additions*:

1. You may add newly hired employees on the first of the month following the date of hire.**
2. You may add employees that have been in your employ more than 31 days if they are transferring from another BCBSRI or another carrier's health plan (certificate of coverage required); or as otherwise required by law or regulation.
3. You may add employees who have been in your employ more than 31 days and are not currently enrolled on the anniversary date or as otherwise required by law or regulation.

We must receive notification within 31 days of when employees and their dependents become eligible for coverage. All requests for additions received after 31 days of eligibility will be denied and can be applied for on your group's next anniversary date, unless otherwise required by law or regulation.

Effective August 2, 2001, regulations were issued by the Rhode Island Department of Business Regulation. These regulations require that each member or prospective member who chooses to waive coverage for themselves, their spouse, or dependent(s) must sign a "Small Group Waiver Form/Certification." If a member refuses to sign the waiver form, the employer must sign the form instead.

Changes*:
All requests for changes received after 31 days or the date of the qualifying event will be denied and can be applied for on your next anniversary date. Changes are always effective on the first of the month after the date of the qualifying event.

Change to family is allowed within 31 days of:

1. The date of marriage.
2. Transfer of spouse from another BCBSRI membership or from another carrier's health plan.
3. The date a spouse has returned from military service.
4. The birth, adoption of a child, or placement for adoption (documentation required).
5. Other qualifying events as required by laws, regulations, or on the anniversary date of your group.

Change to individual is allowed at any time. However, the only opportunity to change back to family will be in accordance with the regulations stated above.

Change in Plan is allowed only:

1. On the anniversary date of your group; or
2. When transferring from another BCBSRI membership (i.e. upon initial enrollment of a member in your group).

Cancellations*:

Retroactive cancellations are NOT allowed.

1. Cancellations become effective the first of the month following termination of employment. WE MUST RECEIVE notification at least five working days prior to the requested date of termination. If we do not receive notification in time, your company will be liable for another monthly premium.
2. Subscribers on sick leave, temporary layoff, or leave of absence must be cancelled on the first of the month following absence unless prior arrangements are made with BCBSRI.
3. We may terminate enrollment immediately in the event of fraud or misrepresentation.

* A completed Group Activity Report must be used with all additions, changes, and cancellations.
** Your company's probationary period for new hires may vary and can be changed, via written request, ONLY on your company's anniversary date.