Eligibility & Enrollment

Worker Eligibility

In order to be eligible to enroll in the WELS VEBA Group Health Care Plan (WELS VEBA), a worker must:

  • Be an active worker in an eligible Sponsoring Organization; and
  • Be hired or called, and compensated, to work at least 20 hours per week and for five or more months per year.

Initial Enrollment Period for New Workers

In order to enroll in WELS VEBA, a new worker must complete the online health enrollment form through the WELS Benefits Service Center website within the first 60 days of the worker’s employment start date. If the appropriate form is not completed within this time period, a new worker will only be eligible to enroll during an open enrollment period or if special enrollment rules are met during the Plan Year. Please see the Special Enrollment Rules section below for further information.

If the eligibility and enrollment rules listed above are met, the new worker’s coverage will become effective on the latest of the following dates:

  • Employment effective date
  • Date enrollment form is completed
  • Date requested for coverage, but not more than 60 days after employment start date

Open Enrollment Periods

Open enrollment periods provide the following enrollment opportunities:

  • Eligible workers may enroll themselves and eligible family members for new WELS VEBA health plan coverage
  • WELS VEBA health plan members may change deductible options and/or add eligible family members

Open enrollment periods are held solely on a discretionary basis as determined by the WELS VEBA Commission. There is no guarantee that an open enrollment period will be held each year.

Please note: There is no open enrollment period for the WELS VEBA-sponsored UnitedHealthcare Medicare program.

Annual Enrollment Periods

Annual enrollment periods provide WELS VEBA health plan members the ability to change their WELS VEBA deductible options (but not to add family members).  Annual enrollment periods are generally held in October-November each year with coverage changes becoming effective January 1 of the following year.

Life Events for Special Enrollment

If an eligible worker or family member experiences any of the following life events, the worker may enroll in WELS VEBA or make changes to existing WELS VEBA coverage:

  • Gaining a dependent through marriage, birth, adoption or placement for adoption
  • Taking a new call or position to a new Sponsoring Organization*
  • Loss of eligibility for other creditable coverage
  • Change in eligibility status for Medicaid and/or Children’s Health Insurance Program (CHIP)

Life events must be reported to the WELS Benefits Service Center using the contact information below within 60 days of the date of the event for benefit changes to be made.

WELS Benefits Service Center
1-800-487-8322 (option 1)

* Please note: If you take a new call or position to a new Sponsoring Organization, the WELS VEBA health plan coverage in effect at your previous Sponsoring Organization will automatically be made effective at your new Sponsoring Organization without a break in coverage. Your new Sponsoring Organization will automatically be billed for your WELS VEBA health plan beginning with the effective date of your new employment. If you wish to make changes to your WELS VEBA health plan coverage, you must contact the WELS Benefits Service Center within 60 days of your new employment start date.

Child Eligibility

The child of an active WELS VEBA member (including natural child, adopted child, or stepchild) is eligible for dependent coverage under WELS VEBA if the child is under age 26.

Total Disability

Children age 26 or over who are totally disabled may remain covered by WELS VEBA. In order to be considered totally disabled, a child must meet the following eligibility rules:

  • The WELS VEBA member provides more than one-half of the financial support for the child because the child is incapable of self-sustaining employment by reason of intellectual disability or physical handicap; and:
    • The condition began before the child would otherwise lose dependent status under WELS VEBA; and
    • The child has been continuously covered by WELS VEBA.

Surviving Spouse Eligibility

The definition of a surviving spouse is as follows:

  • The spouse of a worker who maintained family or employee + spouse coverage under WELS VEBA at the time of the worker’s death.

WELS VEBA allows a surviving spouse to continue coverage on a self-pay basis.

The surviving spouse must complete the necessary enrollment process to continue health coverage within 60 days of the end of the month in which the worker’s death occurred.

WELS VEBA will cover children who are dependents and were covered by WELS VEBA at the time of the worker’s death. A child may remain covered by the Plan until the child is no longer an eligible dependent. WELS VEBA will not cover new family members acquired by the surviving spouse.

When the surviving spouse is entitled to Medicare, the surviving spouse may continue coverage under the WELS VEBA-sponsored UnitedHealthcare Medicare program.

For further information regarding the surviving spouse continuation coverage, please consult the WELS VEBA Summary Plan Description or contact the WELS Benefits Service Center at 1-800-487-8322 (option 1).