(1) A new Employee's department or agency head shall determine within the first ten days of employment whether the Employee is eligible for Commission coverage. Employees whose duties are Seasonal or Emergency Employment or of a duration of not more than three months with no reasonable expectation of an extension, are not eligible for Commission coverage. Department or agency heads who are unable to determine eligibility shall send all information relating to the new Employee’s work to the Commission for a final and binding eligibility determination. Persons who do not enroll in Commission coverage when they are first eligible may later enroll during the Commission's Annual Enrollment or upon satisfactory proof of loss of other coverage. Once an Employee enrolls in a health plan, the next opportunity to change plans is the GIC’s next Annual Enrollment period, except as otherwise required by law.

(2) Members of the Judiciary who qualify as Employees are eligible for Commission coverage.

(3) Effective Date of Insurance Coverage. Eligible Employees who apply for coverage within ten days of the first day of employment shall be insured on the first day of the month following the earlier of 60 calendar days or two calendar months from the first day of employment. The first day of employment shall be counted when determining the effective date of Commission coverage, and one or more days of authorized leave of absence shall be counted as an equivalent number of days of employment.

(4) Retroactive Health Insurance Effective Date. Employees or dependents may request Commission Health Coverage to begin on the first day of employment or the first day of the health coverage waiting period referenced in 805 CMR 9.01(3), as applicable, if all of the following conditions are met:

(a) the Employee or Dependent is not enrolled in other health coverage and incurs an unplanned and urgent medical expense that exceeds the Employee's full cost monthly premium;

(b) the unplanned and urgent medical expense occurs on or after the first day of employment or waiting period but before the effective date of health coverage;

(c) the Employee requests such coverage in writing and provides satisfactory documentation of the unplanned and urgent medical expense.

Coverage shall become effective as of State Employees' first day of active employment or Municipal Employees’ first day of the waiting period, subject to their timely payment of the full-cost health insurance premium for the entire hiatus period. New Employees who begin employment on the 16th day of a month or later will not be charged premium for that month; new Employees who begin employment on or before the 15th day of a month shall be charged the full premium cost for the month. Coverage entitles the Employee only to those benefits that are otherwise available through the health plan selected, and claims may be denied in whole or in part, consistent with the health plan’s covered benefits.

Employees' effective date of life insurance shall only become effective as described in 805 CMR 9.01(3) or 805 CMR 9.02.

(5) Employer Notification to New Employee. The Employee's department or agency head or Group Insurance Coordinator shall inform newly hired employees whether they are eligible for Commission coverage and what benefits are available to them, including Consolidated Omnibus Budget Reconciliation Act (COBRA) continuation coverage. The Group Insurance Coordinator shall also notify newly hired employees that premium deductions for Commission coverage are taken one month in advance of coverage.

(6) New Employees' Duty to Notify Employer. Eligible Employees who are advised by their department or agency head that they are eligible for Commission coverage shall, within ten days of beginning work or beginning the health care waiting period, inform their employer whether they intend to enroll in Commission coverage. Those enrolling in Commission coverage shall promptly select coverage and complete all necessary forms. Persons who fail to enroll in Commission coverage when first eligible may do so during the next occurring Annual Enrollment period or with satisfactory proof of loss of other coverage.

(7) Premium payment for Commission coverage must be made one month in advance of coverage in order for coverage to become effective.

(8) As a condition of employment, employees shall provide information to the Commonwealth as required by law, including but not limited to disclosures required by the Health Care Reform Act.

(9) If an employee is requesting a coverage effective date change to a different month, the employee's effective date of coverage shall be determined by the Commission, and is subject to receipt of premium before coverage becomes effective.

(10) Recalled Employees who do not continue their coverage with the Commission during the period when they are laid off shall be treated as re-employed persons, consistent with § 9.19.


This information provided by the Group Insurance Commission.