Belmont Buzz

Late Applicants and Medical Evidence: What You Need to Know

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Late Applicants and Medical Evidence: What You Need to Know

Let’s talk about Sue.  Sue works at ABC company.  She has been working at the company forever and is a valued employee.  Sue calls in sick, and she is one of those employees that never gets sick.  She is the first one to show up in the morning and she is the one that always has a smile on her face.  (Seriously, how does she do that every morning?)  

Her employer is surprised that Sue is not at work and reaches out to her.    Sue has been given bad news at her recent doctors visit, and is asking what benefits are available to her.   The employer investigates it and sees that Sue did not take advantage of the benefits program when she was eligible, because she felt it was too costly at the time.  Now that so much time has passed, what are her options? 

Sue would be considered a “late applicant” and medical evidence would be required to access the group insurance program, now that her initial eligibility time frame has passed.  What this means is that she would need to complete a medical statement and coverage may be denied now, with her recently discovered medical condition.

If Sue had taken advantage of the medical coverage when she first satisfied the waiting period and met the eligibility requirement (different for every contract), she could have been added to the program without medical evidence.  (It doesn’t matter if the employee has a medical condition). While some employees may indicate that the program is too costly, we recommend that the benefit program be mandatory for all eligible employees, so no one has to be faced with a situation like Sue’s.

If you are an employee and not on the company employee benefits program, contact your employer to inquire if you are eligible.  If you are an employer, review your list of employees under the program to make sure that all employees who are eligible are added.   

We at Belmont specialize in group benefits and our salaried advisors are here to review your program or discuss implementing a new program. We offer consultations as well, so you can be assured you’re providing the best options for yourself and your company. 


| Categories: Expert Opinion | Tags: late applicant, medical evidence, insurance, coverage, benefits | Return
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