Actively at Work Provision

[Guest deacon]

Our employee eligibility provision use to state that employees may enroll on the first day of the month following sixty continuous days of being actively at work for the company. Due to HIPAA we changed this to eligible fot enroll on the first day of the month following sixty days of employment. An employee must have actually begun work before coverage may become effective. Is this verbage permissable under HIPAA or does anyone have a good example of how eligibility requirements can be worded in the SPD? We also took out the definition of actively at work?

[GBurns]

I do not understand your post.

You state that the employee is eligible to enroll on the first day of the month following sixty days of employment the employee must have actually begun work. Then you say that the employee must actually have begun work for the coverage to be effective.

How could the employee finish the sixty days if they never started working?

If you meant that they must turn up for work on that first day, then you still have the actively at work requirement that is not allowed by HIPAA.

[Guest deacon]

We think we have to delete the actively at work statement however, the reason for the statement that an employee must have begun work before coverage may begin is so if an employee is hired for example on Jan 1 and coverage is to begin March 1 and the employee never actually begins working. Do you know were the actively at work exclusion is cited in the regs? Thanks.

[GBurns]

HCFA Program Memorandum 00-04 relates to actively-at- work requirements.

HCFA Program Memorandum 00-01 relates to non-confinement requirements.

Also www.ebia.com/weekly/articles/HIPAA001005HCFAMemo.html

And, of course, do a search on Benefits Buzz and the Benefitslinks Boards.