For the purposes of your group benefit plan, an employee must be fully capable of performing the regular duties of their occupation, and must be actually working in their usual place of employment (or a place required by the employer), for the minimum hours per week specified in your Booklet(s), in order to be considered “Actively at Work,” or “Actively Working.”
- An employee is considered to be Actively Working if they are absent due to scheduled vacation, weekends, statutory holidays or shift variances, as long as they were Actively Working on their last scheduled workday.
- An employee is not considered to be Actively Working if they are receiving disability benefits or participating in a partial disability or rehabilitation program.
As the Plan Administrator, you must confirm if an employee is Actively at Work in many situations and notify your Billing Administrator within 31 days:
- When a new employee is hired, the employee must be Actively at Work on the date insurance coverage is scheduled to take effect; otherwise they are not covered until they return to work;
- When there is a change in the amount of an employee’s coverage, the change will not take effect until they are Actively at Work (ex. salary changes that increase benefits);
- When an employee becomes disabled, the date of disability will be based on the date the employee stopped working due to their illness or injury; and
- The Insurer may verify the Actively at Work provision before certain claims will be paid.