Enrollment Information

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.

Eligible Dependents

An eligible dependent of a covered employee includes:

  • Spouse.
  • Your dependent children up to age 26, who are (1) a natural or legally adopted child of the subscriber, (2) foster child of the subscriber, (3) a child for which the subscriber is a court-appointed guardian, or (4) stepchild of a member who is married to the stepchild's natural parent.
  • Your dependent children who meet the requirements of SHP-POL-1006-SHP, including being covered by the Plan when they turn 26 and qualifying as disabled.

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.

Adding a Baby to the Plan

Open Enrollment

During Open Enrollment, members can:

  • Enroll in the State Health Plan
  • Disenroll from the State Health Plan
  • Switch between plans
  • Add or remove dependents without a qualifying life event

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.).

Click here to download the 2024 Open Enrollment poster

HBRs are asked to review and understand the following rules...

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  • Must enroll themselves and their dependents within 30 days from their date of hire.
  • Can add/drop dependents
  • Must occur within 30 days from a qualifying life event.
  • HBR Checklist for new employee onboarding

Icon representing a yellow light bulbEmployees can opt out of the Flexible Benefit Plan, IRS Section 125 and view a list of qualifying life events.

View the Form

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Employees must upload documents into eBenefits or provide supporting documentation to their Health Benefits Representative to verify the qualifying life event in accordance to State Health Plan policy. Employees are also required to provide documentation of a dependent’s eligibility when added to the Plan due to New Hire event, QLE, or Open Enrollment.

View the List of Supporting Documents

 

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Terminations of health coverage must be processed within 30 days. Groups will be responsible for paying the premiums for members who were not terminated in a timely manner.

Please note: The rules for the termination of health coverage due to an employee's end of employment as established by 135-48.44 is as follows:

Employees who are paid less than 12 months and summer months:

  • 135-48.44 (a) (2) The last day of the month in which an employee's employment with the State is terminated as provided in subsection (d) of this section.
     
  • 135-48.44  (d) (4) If employment is terminated in the second half of a calendar month and the covered individual has made the required contribution for any coverage in the following month, that coverage will be continued to the end of the calendar month following the month in which employment was terminated. This has been determined by legal to be terminations that occur on and after the 16th of the month.
     
  • State agencies (people who enroll through BEACON) follow 135-48.44 (d) (4).
     
  • Public schools, community colleges, local government units, charter schools and other non-BEACON groups basically can make the determination on which rule they wish to follow, but they need to make a decision that will be the standard they follow.

Employees who are paid less than 12 months and summer months:

  • 135-48.44  (d) (4) Employees paid for less than 12 months in a year, who are terminated at the end of the work year and who have made contributions for the non-work months, will continue to be covered to the end of the period for which they have made contributions, with the understanding that if they are not employed by another State covered employer under this Plan at the beginning of the next work year, the employee will refund to the ex-employer the amount of the employer's cost paid for them during the non-paycheck months.