Enrollment Guidelines

More complete information can be found in Section 7 of the Explanation of Coverage or Summary Plan Description.

When can an employee enroll?

  • Upon the company's initial effective date.
  • During the company's annual Open Enrollment Period.
  • Within thirty-one (30) days of your date of hire (or thirty-one (30) days after meeting the employer's waiting period.)
  • Within thirty-one (30) days of first becoming eligible under the employer's policy (for example, an employee switches from part-time to full-time and therefore, becomes eligible for coverage under the Plan);
  • Within thirty-one (30) days after moving your residence into the HNE service area.

Are there any times when an employee can enroll outside the above time periods?

Yes. Under the Health Insurance Portability and Accountability Act (HIPAA), if they did not enroll in the Plan when first eligible, they will be allowed to enroll themselves and their eligible dependents at a later date if any of the below conditions are met:

  • They did not enroll in HNE because they, their spouse or an eligible dependent had other insurance when they otherwise became eligible to enroll in HNE, and that coverage was subsequently lost as a result of a certain event, such as a loss of eligibility for coverage, expiration of COBRA Continuation Coverage, termination of employment or reduction in the number of hours of employment, or because employer contributions towards such coverage were terminated:
  • If the employee marries; or
  • If they acquire a new dependent through birth, adoption or placement for adoption

If the employee meets any of the above conditions, they must make a written request for enrollment within thirty (30) days of the date of the event. Their coverage with HNE will be effective as of the date of the event.

How do they enroll?

To enroll in HNE they must meet the eligibility requirements listed in the Membership Agreement. They must also submit the following to HNE within thirty-one (30) days of the requested effective date of coverage: a completed and signed Enrollment/Add form, any other forms or information as HNE may request.

What happens if an employee are already enrolled but then marry, or acquire a new dependent?

If an employee marries or acquire a new dependent, the new dependent may be add to the Plan. The employee must submit an Enrollment/Add Form to Health New England within thirty (30) days of the marriage or acquisition of the new dependent. Health New England may require documents that prove the new dependent is eligible. If the new spouse or dependent is not enrolled within thirty (30) days they may be added only at the company's next Open Enrollment Period. 

The effective date of coverage for new dependents will be
the date of:

  • Marriage
  • Birth
  • Adoption or placement for adoption
  • Legal guardianship or
  • The subscriber becoming legally responsible for the dependent's health care coverage

834 Enrollment Companion Guide

Health New England has developed this Companion Guide as a support tool for our Trading Partners when submitting electronic HIPAA 5010 Membership Enrollment. Health New England accepts such enrollment in the format described in the ASC X12 Standards for Electronic Data Interchange Technical Report Type 3, ASC X12 834, version 005010. (We also may refer to this as the TR3, or “the Guide.”) Health New England will accept enrollment in the format consistent with form 005010X220A1, published in June 2010.

All X12 Guides may be purchased from the Washington Publishing Company at http://www.wpc-edi.com.

Our Trading Partners may select from several different options for filing enrollment electronically:

  • Clearinghouses (Third Party Administrators) – For a complete list of Trading Partners that Health New England transacts with, click here.
  • Employer Groups can submit files through MyHNE, our secure website (Health New England Employer Groups only).
  • All Trading Partners can submit files to our FTP server.
  • Health New England can retrieve files from a Trading Partner’s FTP server.

If you are not filing your enrollment electronically and you would like more information, please contact your Employer Group’s Health New England Sales Representative.

Companion Guide >

HNE