All about enrollment

Everything you need to know about enrolling new employees in your health plan or changing information for current employees.

Have a Group Medicare plan? Group Medicare rules and enrollment instructions are different from other group plans. Go to group Medicare information. 

Jump down to:
Enrolling new employees & their dependents
Open enrollment
Special enrollment periods
Status changes

Enrolling new employees & their dependents

1. Employee fills out an Enrollment form (763KB PDF) within 31 days following their eligibility date.
   Note: If you offer a health flexible spending arrangement (FSA), you must use the FSA enrollment form (531KB PDF) to enroll employees or make changes. 
2. They keep a copy to use as a "temporary identification card" until they receive their new card(s) in the mail.
3. You keep a copy for your records.
4. Process their enrollment instantly using the online Enrollment tool. (You must be logged-in to access the tool.)
    View a demo of the online Enrollment tool.
5. We'll send ID cards, a Member Handbook, and a Schedule of Copays and Deductibles right to the employee. (The Certificate of Coverage is available in the Member Center or from Customer Service.)

If you can't use the online Enrollment tool, send the completed enrollment/change form to the Enrollment department:

Email: enroll@priorityhealth.com
Fax: 616 942-5242
Mail:
Priority Health
Enrollment
P.O. Box 205
Grand Rapids, MI 49501-0205

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Open enrollment

You work with Priority Health to determine when your open enrollment period takes place. It generally happens just prior to your plan year renewal. During open enrollment, employees may make changes in their coverage:

• Enroll themselves or eligible dependents (if not already enrolled)
• Change their benefit plan (when multiple plan options are offered)

30-day pre-renewal (open enrollment) lockout

Online enrollment is locked 30 days before your renewal date:

• You can terminate or disenroll members.
• You can't update member information (address changes, adding dependents) or enroll new members. Wait until your 30-day lockout is done or submit a Change form for these updates. Open Change form (514KB PDF).

Waiver of coverage - for small groups (2-50 eligible employees)
Many employer groups allow their employees to decline all or part of the health coverage offered. This is known as "Waiver of Coverage." It's important that the employee fully understands any future enrollment limitations if they decline coverage.

Have every employee who declines coverage fill out a Waiver of Coverage form (32KB PDF).

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Special enrollment periods

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) established "special enrollment periods." This allows eligible dependents to enroll in the plan at times other than their initial eligibility or during an open enrollment period. Special enrollment periods include:

• Enrollment of newly eligible dependents - An employee who gains a new dependent due to marriage, birth, adoption or placement for adoption may enroll himself (if not already enrolled), their spouse (if not already enrolled) and any other new dependents within 31 days of the enrollment event.
• Loss of other coverage - An employee may enroll himself and eligible dependents within 31 days following their lost of other insurance coverage. The employee must provide proof of the lost coverage from their previous carrier.

HIPAA requires you to notify each employee of their enrollment rights on or before the date the employee is offered enrollment in the plan. Information about special enrollment periods under your plan is detailed in your group agreement. You'll find additional HIPAA information in the member confidentiality section of this manual. 

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Status changes

1. Have the employee fill out a Change form (514KB PDF) for
   • Small changes, such address or name changes 
   • Large changes, such as terminating coverage, adding or terminating dependents or making plan option changes
2. Or a PCP Change form (1.6MB PDF) to change their primary care physician. (The employee can also change their PCP while logged in to their Member Center)
3. Process the changes instantly using the online Enrollment tool. (You must be logged-in to access the tool.)

If you can't use the online Enrollment tool, send the completed enrollment/change form to the Enrollment department:

Email: enroll@priorityhealth.com
Fax: 616 942-5242
Mail:
Priority Health
Enrollment
P.O. Box 205
Grand Rapids, MI 49501-0205