Details on special enrollment in City of St. Louis benefit plans
Special Enrollment Periods
Employees and their dependents may be eligible to join the plan outside of Open Enrollment if they qualify for special enrollment. Except as noted otherwise below, the employee or dependent must request special enrollment within 31 calendar days of a qualifying event. Members who enroll during special enrollment are not considered late enrollees.
Qualifying events that allow for a 31 calendar day special enrollment period include:
- Lost eligibility under a prior health plan for reasons other than non-payment of premium or due to fraud or intentional misrepresentation of a material fact.
- Exhausted COBRA benefits or stopped receiving group contributions toward the cost of the prior health plan.
- Lost employer contributions towards the cost of other coverage.
- New eligibility for coverage due to marriage, birth, adoption, or placement for adoption.
- Additional events such as divorce, death, or court support order for coverage
Qualifying events that allow for a 60 calendar day special enrollment period:
- The employee or dependents Medicaid or Children's Health Insurance Program (CHIP) coverage is terminated as a result of loss of eligibility.
- The employee or dependent becomes eligible for a subsidy (state premium assistance program).
A request for special enrollment must be made within the 31 or 60 calendar day deadline associated with the specific qualifying event.
Required documents for qualified/reportable event(s):
- Consolidated Enrollment Form;
- Certificate of Coverage, for lost coverage;
- Documentation supporting the event change.
If the Subscriber does not enroll themselves and/or their Dependents when first eligible or during a Special Enrollment period, they will not be eligible to enroll until the next Open Enrollment Period.
Phone: (314) 622-5743, (314) 622-5753, (314) 613-7084