How Do I Declare a Leave Without Pay Event?
Employers have certain responsibilities in administering coverage for its employees on Leave Without Pay (LWOP). Employees currently covered by SHBP and employed with an SHBP Employing Entity, i.e., Active Members, may maintain coverage while on LWOP for twelve (12) calendar months.
Employer responsibilities include but are not limited to:
- Timely notifying SHBP of employees who are currently covered by SHBP and approved for LWOP, who would like to continue coverage within 30 days of their approval for LWOP
- Timely notify SHBP of employees who are currently covered by SHBP and on LWOP, who lose eligibility for SHBP coverage for any reason (e.g., non-payment or termination from employment) within 30 days of their loss of eligibility.
Below are the steps you must take to notify SHBP of employees currently covered by SHBP who become eligible or ineligible to continue SHBP coverage during LWOP:
Within 30 days...
Within 30 days of an employee becoming eligible or ineligible to continue SHBP coverage during LWOP, Employers must declare the event by notifying SHBP Employer Services by submitting a LWOP inquiry via the SHBP (X)change System 24 Hours a Day/7 Days Per Week (for instructions on requesting access to the (X)change, click here).
If an Employer fails to timely notify SHBP Employer Services within 30 days:
- The employee is ineligible to continue coverage while on LWOP, and must wait until the next Open Enrollment period, unless they experience another Qualifying Event or Special Enrollment Event to make a change to their coverage.
- Employer must immediately transmit a Record updating the employees’ SHBP Eligibility status to an SHBP Ineligible status.
Note: If the employee is terminated, a Termination Record should be transmitted to SHBP immediately. An inquiry via the (X)change should not be submitted for terminations.
Within 45 days...
Within 45 days after you notify SHBP Employer Services via the (X)change, Employers must provide the following documentation:
For Employees Who Become Eligible: provide documentation with the name of the employee who became eligible for LWOP, date the employee became eligible for LWOP, and reason they became eligible for LWOP.
For Employees Who Become Ineligible: provide documentation with the name of the employee who loss eligibility for LWOP, date the employee loss eligibility for LWOP, and reason they loss eligibility for LWOP.