Haw. Code R. 24-4.05 - 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. Failure to provide the required proof documents within sixty (60) days of the event shall result in the reversal of the requested enrollment changes retroactive to the effective date.

(b) A properly completed enrollment application must be filed within thirty (30) days of the specified event that allows the filing of the application except in the case of newborns for which the enrollment application must be filed within one hundred eighty (180) days of the birthdate, and except for periods of open enrollment (see Rule 4.08).

(c) An employee-beneficiary who fails to file an enrollment application within the time prescribed by subsection (b) above or any otherwise applicable rule shall not be permitted to file that application until the next regular open or additional limited enrollment period.

Notes

Haw. Code R. 24-4.05