Life Events & the 31-Day Rule
Picture this: an employee proudly announces a new baby. You congratulate them, everyone coos over photos… and six months later, a prescription claim for that same baby is declined because they were never added to the plan. Cue stress, finger-pointing and a long call with the insurer.
Most group benefit contracts in Canada give members a limited window, typically 31 days, to report a “life event.” That includes things like marriage or cohabitation, birth or adoption of a child, loss of spousal coverage, or a change in student status. If the change is reported on time, adding the dependant or employee is typically seamless.
Miss the window, and your otherwise healthy employees or their dependants instantly become a “late applicant.” That often means medical questionnaires, potential exclusions, dental waiting periods, or outright declines. From the member’s perspective, it feels like a broken promise: “I thought my family was covered.” From the employer’s perspective, it can feel like you’re stuck in the middle of a dispute you didn’t create.
This is why a simple, boring process is your best friend. A few practical ideas we encourage:
• Bake benefits into your HR life-event checklist – new baby, marriage, divorce, loss of spousal coverage, cohabitation with a partner, dependants aging out.
• Remind employees at least once a year that they must tell you about these changes within the deadline in your contract.
• Keep signed forms (or electronic confirmations) so that, if there is ever a question, you can show when a change was requested. A reminder here to use our employee acknowledgement form!
• For remote or growing teams, consider one central point of contact or shared inbox for all benefit changes.
We already use your carrier’s specific rules when we design and review your processes with you. If you’re not sure what the time limits are for your plan, or where late-applicant rules might trip you up, we’re happy to walk through it together and tighten any gaps now – before a tough claim puts everyone in a bad spot.
Beating the 31-Day Rule
We started a conversation about this topic on LinkedIn. If you’d like to see the discussion or share it with your network, you can view the post here.