Eligibility & Effective Dates

The Eligibility & Enrollment Guidelines section contains four major segments. The name and general contents of each section are listed below.

• Enrollments: Description of eligibility, effective dates, and enrollment guidelines for members.
• Beneficiary: Guidelines and procedures to designate beneficiaries to receive insurance proceeds payable under the plan in the event of death.
• Changes: Guidelines and procedures for changing a member’s information.
• Terminations: Guidelines and procedures for terminating a member’s coverage.

Enrollments

Eligibility
The eligibility date is the date on which the employee meets all eligibility requirements and becomes eligible for insurance in accordance with the provisions in the Certificate of Insurance or Group Policy.

For employees, the eligibility date is the date of employment plus the waiting period (if any) specified in the Certificate of Insurance or Group Policy.

Eligibility maintenance is handled by submitting all eligibility information to Trustmark.

Eligibility maintenance can be handled two ways:

• Utilize Express, Trustmark’s Benefit Administration Self Service Center - Express is a safe and secure Internet application that allows you and your employees to enter, update, and maintain benefit selections using automated transactions. Express is available 24/7 and lets your employees make their benefit selections and updates at home with their families. As a Group Administrator, you have full access to all of your employee’s enrollment screens and menu choices along with additional benefit administration tools. If you would like additional information about Express and it’s capabilities, please contact your Client Manager or Employer Service Representative.
  
• Manually submit all eligibility records and forms to Trustmark.

Effective Dates
The date on which group insurance coverage becomes effective for individual employees depends on the provisions in the Certificate of Insurance or Group Policy. In general, effective dates are calculated according to one of the following basis:

• First day of insurance month.
• Date of eligibility, if the signature date on application is on or before that date.
• First day of the month after the date of application, if the signature date is within 30 days after your date of eligibility.
• Date approved by Trustmark, if Evidence of Insurability Form is required.

Please refer to the Certificate of Insurance or Group Policy for more information on effective dates.

The interpretation of these dates depends on whether the plan is non-contributory or contributory.

Effective Dates for Non-Contributory Plans
This section explains how to determine effective dates for non-contributory plans. A non-contributory plan is a plan where the employer pays the entire premium for the insured’s coverage, or the insured pays all or part of the premium with pre-tax dollars as in the case of a Section 125 Plan.

Standard Contract: After timely receipt of the Enrollment and Medical Statement, the effective date of coverage is the first of the month following the completion of the waiting period.

Immediate Contract: After timely receipt of the Enrollment and Medical Statement, the effective date of coverage is immediate following completion of the waiting period.

All employees must be enrolled as they become eligible. Non-contributory coverage may not be waived.

Effective Dates for Contributory Plans
This section explains how to determine effective dates for contributory plans. A contributory plan is a plan where the insured shares in the cost of the plan along with the employer.

Standard Contract: Upon timely receipt of the enrollment card, if the signature date on the enrollment card is on or before the date he or she is eligible, the effective date of coverage is the first of the month following the completion of the waiting period.

Immediate Contract: Upon timely receipt of the enrollment card, if the signature date on the enrollment form is on or before the date he or she is eligible, the effective date of coverage is the date on which the employee completes the waiting period.