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Eligibility & Enrollment

Eligibility

Eligible Employees are officers or employees of state agencies, departments or institutions who are working twenty (20) hours or more per week and expected to work at least five (5) consecutive months.

Eligible Dependents include legal spouses and children up to their 26th birthday. Upon marriage employees may add their spouse as a dependent within 60 days from the date of marriage for a 1st of month effective date.

Enrollment

Employees are responsible for submitting the appropriate enrollment forms and documents. For new hires, coverage begins as of the first of the month following date of hire if the enrollment form is submitted within 30-days of date of hire. For existing employees electing coverage for themselves or dependents throughout the year, coverage begins the first of the month following date of application. To add a newborn dependent to coverage, enrollment forms must be submitted within 60-days of the date of birth for coverage effective as of the date of birth.

Employees can obtain specific enrollment information and instructions from their human resource offices.

Employees whose agencies are on the State Controller's Office payroll system MUST submit their medical, dental, Premium Only Plan (pre-tax deductions) and Flexible Spending Account (FSA) enrollment electronically via the Employee Self Service portal. Life insurance enrollment forms are not available online and must be submitted in a hardcopy. 

Employees whose agencies maintain their own payroll system must complete hardcopy forms for all coverages.

All submitted enrollment forms are reviewed for accuracy by the Office of Group Insurance before they are transmitted to our insurance carriers. 

Once an employee has enrolled in a medical plan, they may decline coverage at any time, but they cannot change to another plan type until the next open enrollment period. Enrollment timeframes are contractually established; exceptions are not permitted under the contract.

Dependent Eligibilty Verification (DEV)

Employees who enroll dependents in any of the State's medical plans are required to provide appropriate documentation to meet the eligibility criteria for coverage. HMS Employer Solutions conducts the verification process.

Following submission of the enrollment form, HMS will contact the employee by email AND mail at the email address and mailing address listed on the enrollment form. The communication from HMS will include step-by-step instructions to submit the appropriate documentation to verify a dependent's eligibility, as well as a toll-free customer service number.

Failure to complete the verification process could result in an interruption in your dependent's coverage. You may contact the Office of Group Insurance at any time with questions about the DEV process.

DeV Mobile Friendly Site

HMS/AuditOS

Ineligibility

Ineligible Employees are those classified as a "seasonal employee" or a "part-time temporary" employee.

  1. Seasonal Employee. A position which the customary annual employment is six (6) months or less.
  2. Part-Time Temporary Employee. Expected, at the time of hire, to work twenty (20) hours or more per week but less than thirty (30) hours per week, and whose term of employment is not expected to exceed five (5) consecutive months.

Dual Enrollment - Not Permitted

A participant cannot be covered as both an employee and as a dependent on the State's group plan. If an employee's spouse is employed by any agency in the State's group insurance program:

  • One employee can waive medical coverage and be covered as a dependent spouse of the other
  • Each employee can enroll in the self-only coverage

The same applies to dependent children. Dependent children may only be covered under one employee's plan.

 

 

Switching Agencies?

If you are an existing employee transferring employment from one agency to another you MUST re-enroll for all coverages. As part of your re-enrollment due to transferring, you may not change your benefit elections or elect previously declined coverages.

If you have no break in service, you will not be required to repeat the dependent eligibility verification for medical/dental coverages.

Switching Agencies