Haw. Code R. § 4.05 - Failure to File Properly Completed Enrollment Application Within the Prescribed Time; Effect on Coverage Dates

Except as otherwise provided in these rules or by applicable federal or state law, the following shall apply to all applications to enroll in the benefit plans offered or sponsored by the Fund, to add or delete dependent-beneficiaries, or to change enrollments or coverages:

(a) No enrollment of an employee-beneficiary, addition or deletion of a dependent-beneficiary, or change in an enrollment or coverage shall be effective without the filing of a properly completed enrollment application and any required proof documents within forty five (45) days of the specified event that allows the filing of the application except for the following events:

(1) termination of employment for which the enrollment application must be filed within thirty (30) days of the termination of employment;

(2) newborns for which the enrollment application and required proof documents must be filed within one hundred eighty (180) days of the birth;

(3) retirement, and surviving spouse, partner or child who become eligible as an employee-beneficiary under Rule 3.01 for which an enrollment application and required proof documents must be filed within sixty (60) days of the event;

(4) cancellation of enrollment in a Fund benefit plan upon acquiring coverage from a non-Fund plan must be filed within ninety (90) days of the event.

(b) An employee-beneficiary who fails to file an enrollment application and required proof documents within the time prescribed by subsection (a) above or any otherwise applicable rule shall result in the rejection of the requested enrollment changes and not be permitted to file that application until the next regular open or additional limited enrollment period.

(c) An application will not be processed if it does not include a Social Security (SSN) for an employee-beneficiary and/or a SSN or Individual Taxpayer Identification Number (ITIN) for a dependent-beneficiary for whom enrollment is being requested. The employee-beneficiary and/or dependent-beneficiary shall be added retroactive to the effective date of the event upon the Fund's receipt of the employee-beneficiary and/or dependent-beneficiary's SSN or ITIN.

Notes

Haw. Code R. § 4.05

Eff 8/13/2016 Eff 10/18/2019 Am 12/1/2023 Am 10/10/2024