Policy/Memo 95

Number: Policy Memo 95
Date Issued: September 24, 1996
Policy File Ref: A1020

ISSUE:

Determine how many waivers of premium an enrollee is entitled to, and how soon after returning to the payroll may another waiver be applied for.

Background:

An employee had received a one year waiver of premium. At the end of the waiver period, the agency proposed using the employee's accrued vacation to put the person back on the payroll for one day and then advising the enrollee to apply for another waiver.

Policy:

An enrollee must return to work before being eligible for additional waivers of premium. A person who has not returned to work may not use accruals to return to the payroll for a brief period in order to qualify for an additional waiver. When an employee has received a waiver of premium, returns to work and then leaves work due to illness, the following rules will apply:

• If the enrollee returns actively to work and continues health insurance coverage, but must stop working due to a disability after less than six consecutive biweekly payroll periods following the return to work, *the enrollee may resume coverage under the previous waiver for the remainder of the original one year period which includes the time back to work.
• If the enrollee stops working due to a disability after having been actively at work and continuing health insurance coverage for six or more consecutive biweekly payroll periods*, a new waiver of premium application will be considered for an additional one year period

There is no lifetime limit to the number of waivers an enrollee may receive.

*Three consecutive months for monthly agencies.