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.
Employees can obtain specific enrollment information and instructions from their human resource offices.
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. 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.
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.
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.
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.
Effective Dates of Coverage
Effective dates of changes to coverage are based on the date the employee submits their enrollment forms.
|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.