Enrollment and Eligibility
Initial Enrollment (new hire)
Members are eligible to enroll in the Plan if they work for a participating employer and are a regular assigned, full-time Employee working 15 or more hours per week. This also includes Board Members or other individuals who are required to be covered by State or Federal Law, regardless of hours worked.
To enroll in the Plan, you must complete the online enrollment process within 31 calendar days after your hire date by logging into nbhp.benelogic.com .
Proof Of Eligibility Requirements
If the spouse is eligible for employer-sponsored or retiree medical coverage and would have to pay more than 50% of the total premium rate for their individual/single rate, they can stay on the NBHP plan as primary. Otherwise, they are only eligible to be on the Plan as secondary.
As part of the enrollment process, you will be required to answer the spousal questions located in the Benelogic system. If your spouse is eligible to be secondary, their primary insurance information will need to be entered in the Coordination of Benefits (COB) section of the enrollment process.
If your spouse is employed but does not have access to an employer-sponsored medical plan, you will be required to have your spouse’s employer complete the Spousal Employer Verification Form. The form can be printed from either this site or from the Resource Tab in the enrollment portal and then once complete, uploaded to your Benelogic file cabinet.
Each year you have the opportunity to change plans and add or drop dependents without a Special Enrollment Event. Open enrollment occurs in the fall of each year with coverage effective January 1 of the following year.
During the designated open enrollment time period, login to the Employee portal at nbhp.benelogic.com.
When Coverage Can Be Added Or Terminated
In general you cannot change or drop your health benefits unless it is done during the plan’s annual Open Enrollment, or you experience a qualifying event and make the change within 31 days of the event.
Family Status Changes
When family status changes occur, the last thing on your mind is to update your employer. However, failure to notify your employer may cause your medical claim payments to be delayed or denied. Also, your rights to enroll in the plan or continue coverage may expire. If a change is necessary, they should be submitted in the enrollment portal via a change request. These changes may include simple things like updating an address or changing your last name, email, or phone number. This would also include Special Enrollment Events that would allow you to make plan changes, or add/delete dependents throughout the year.
Special Enrollment Events include the following:
- Death of a spouse
- Legal separation
- Birth, adoption, placement for adoption or death of a dependent
- Termination or commencement of employment of a spouse
- A dependent or spouse fail to satisfy the plan’s definition of an eligible dependent or spouse
- Loss of eligibility which includes a loss of coverage due to:
- Legal separation;
- Termination of employment, or reduction in hours of employment;
- A plan no longer offering benefits to a class of similarly situated individuals even if the plan continues to provide coverage to other individuals;
- The Employee or Dependent is covered under a Medicaid plan or under a state CHIP program, and coverage of the employee or dependent under such plan/program is terminated as a result of loss of eligibility for such coverage.
Proof of the Event must be uploaded to the Benelogic file cabinet before a change request will be approved in the system.
Remember that your health plan allows you to have your premiums deducted pre-tax. As a result the plan is considered a “cafeteria plan”, and is subject to IRS cafeteria plan regulations. Under these regulations employees cannot drop coverage at any time unless it is during the plan’s open enrollment period or within 31 days of a status change or Special Enrollment Event.
Special provision: Newborns are covered at the moment of birth ONLY if you enroll your new baby in the plan within 60 days immediately following birth. Claims will be denied if you do not enroll your new baby in the plan.
AST (Administrative Support Team)