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 an effective date 1st of month following date of marriage.

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 hard copy.

Employees whose agencies maintain their own payroll system must complete hard copy 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 Eligibility 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. Cotiviti (formerly HMS Employer Solutions) conducts the verification process.

Following submission of the enrollment form, Cotiviti will contact the employee by email AND mail at the email address and mailing address listed on the enrollment form. The communication from Cotiviti 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.

Ineligibility

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

Seasonal Employee. A position which the customary annual employment is six (6) months or less.
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.

Dependent Verification FAQs

Approximately 3 – 4 weeks after you complete your enrollment application to add a dependent spouse and/or child(ren) to your medical and dental plan, you will receive an email and a mailed letter from Cotiviti. Be sure the email address you used on your enrollment form is one you check frequently.

All required documents MUST include date and/or year, employee name, and dependent’s name.

FOR SPOUSE:

A copy of your valid marriage certificate
And one of the following:
- A copy of the front page of your most recent tax return confirming this dependent is your spouse
- A document dated within the last 60 days showing current relationship such as a recurring monthly household bill or statement of account. The document must list your spouse’s name, the date and your mailing address.

FOR NATURAL CHILDREN, STEPCHILDREN, ADOPTED CHILDREN (OR THOSE IN THE PROCESS OF ADOPTION) up to age 26:

A copy of the child’s birth certificate or adoption certificate naming you or your spouse as the child’s parent (first and last names listed). Note, for newborns: A copy of the hospital birth certificate is acceptable provided it includes the names of the baby AND parent(s) AND has been signed by a hospital representative.

*Note for a stepchild: IF you are covering a stepchild you must also provide documentation of your current relationship to your spouse as requested above.

FOR CHILDREN who are legally dependent on you and for whom you maintain a PARENT – CHILD relationship:

A copy of the front page of your current tax return confirm this child is your dependent, AND
A copy of the court order naming you or your spouse as the child’s permanent legal guardian.

Additional guidance will be provided by Cotiviti for verification of disabled children age 26 or older.

If you are missing paperwork or waiting on paperwork, such as a birth certificate, and you are not going to meet the deadline set forth in Cotiviti notification, contact the Office of Group Insurance as soon as possible to discuss your options to maintain coverage for your dependent, ogi@adm.idaho.gov or 208-332-1860.

Failure to complete the verification process could result in an interruption in your dependent’s coverage. Claims incurred during months where your dependent was unverified due to failure to complete the full DEV will not be retroactively covered by the plan.

You can contact Cotiviti through the Cotiviti online verification portal or by calling them directly at 1-855-362-4737.

Cotiviti customer service representatives do not have the ability to make outbound calls. So if you are working with a representative on a specific issue, you will need to call them back to follow up.

What Action is Necessary
Enrolling Newly Acquired Dependents	Employees have sixty (60) days to enroll new family members acquired through marriage, birth or adoption. Coverage for a new spouse or stepchildren will begin the first of the month following the date of marriage. Newborns and newborn adoptive children have coverage on their date of birth; adoptive children older than sixty (60) days will have coverage effective on their date of placement with the employee. If an employee waits longer than sixty (60) days to submit an enrollment form, coverage will be effective the first day of the month following the date of application.
Late Enrollees	Eligible employees can enroll themselves or dependents for medical plan coverage at any time. Dental coverage is automatic for employees; employees may elect those coverages for dependents being enrolled in a medical plan, unless dependent declinations are already in effect. Coverage begins the first (1st) day of the month following the date enrollment forms are submitted.
Declining Medical Coverage	An employee can decline medical coverage for himself/herself or enrolled dependents at any time. To do so an employee must complete and submit a revised Medical and Dental Enrollment Application.
Declining Dependent Dental Coverage	Employees can decline dependent dental coverage at any time. To do so, an employee must complete and submit a revised Medical and Dental Enrollment Application. Once dependent dental coverage has been declined, it can only be added during Open Enrollment.
Open Enrollment	Annual open enrollment is the only time that employees may switch medical plans, change their Premium Only Plan elections or enroll in the FSA. Open enrollment is usually held in May, with changes taking effect the following July 1. All employee elections must be submitted during the open enrollment period; forms submitted after the close of open enrollment cannot be accepted. Each year, the Office of Group Insurance sends all agencies instructions in advance of the upcoming annual open enrollment. We include such details as the exact dates of the open enrollment period and employee deadlines for submitting election forms. We also post information for employees about available benefit options, upcoming changes, and how to enroll for the benefits of their choice on both the Employee Portal and the Group Insurance website. It is the responsibility of the individual agency human resource office to share all open enrollment information/materials provided by the Office of Group Insurance to their employees.