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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. Employees will need to proactively work with their HR/Payroll office to update their payroll deductions when they have a dependent reaching age 26. Review the Qualifying Life Event section for detailed timelines for adding/removing dependents from coverage.

Enrollment

Employees are responsible for submitting the appropriate enrollment forms and documents. Employees can obtain specific enrollment information and instructions from their HR offices.
  • New hires, coverage begins first of the month following date of hire if the enrollment form is submitted within 30-days of date of hire.
  • Existing employees electing coverage for themselves or dependents due to a qualifying life event, other than birth/adoption or marriage, coverage begins the first of the month following date the event.
  • Birth/adoption enrollment forms must be submitted within 60-days of the date of birth for coverage effective as of the date of birth/adoption.
  • Marriage enrollment forms must be submitted within 60-days of the date of event coverage effective first of the month following date of the event.
Employees whose agencies are on the State Controller’s Office (SCO) payroll system MUST submit their medical, dental, Premium Only Plan (pre-tax deductions) and Flexible Spending Account (FSA) enrollment electronically via Luma.
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.

Enrollment timeframes are contractually established; exceptions are not permitted under the contract.

Qualifying Life Events

Qualifying Life Event Information & Summary – with deadlines for each change

You should always elect benefits during Open Enrollment to ensure you get the coverage you need. However, once you make your elections, you are unable to change your elections until the next Open Enrollment period without a Qualifying Life Event.

Making changes due to a Qualifying Life Event has very strict time frames. Most changes must be made within 30-days of the date of the event. Late applications cannot be accepted.

Those life events that allow you to make your benefit elections in the middle of the plan year commonly include:

  • Marriage/Divorce (within 60-days of the date of the event)
  • Birth or Adoption (within 60-days of the date of the event)
  • Death
  • Change in coverage under other employer’s plan (within 30-days of the date of the event)
  • Spouse loss of coverage, etc. (within 30-days of the date of the event)
If you believe you have experienced a Qualifying Life Event, review the Qualifying Life Event Summary PDF, check with your HR or you may contact the Office of Group Insurance at any time with questions.

Disenrollment

You may only disenroll yourself or your dependents for coverage:

  1. At Open Enrollment. Open Enrollment is the last week of April and first two weeks of May every year for enrollment changes that take effective July 1., or
  2. With a Qualifying Life Event (QLE). For example, divorce, gain of other coverage, etc. Refer to the Qualifying Life Event section for specific information. Strict time frames exist for these mid-year changes to your enrollment. If you miss the allowed time frame, typically 30-days from the date of the event, you will not be allowed to disenroll yourself or your dependents until the next Open Enrollment period.

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 in this Plan is 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/dental coverage and choose to be covered as a dependent spouse of the other, or
  • Each employee can enroll for individual coverage.

The same applies to dependent children. Dependent children may only be covered under one employee if the spouses are enrolled in the plan but on separate policies.

Switching Agencies?

If you are an existing employee transferring employment from one agency to another you MAY NEED TO complete your insurance paperwork again to ensure seamless coverage. As part of your re-enrollment due to transferring, you may not change your benefit elections or elect previously declined coverages.

FAQs

The rules for making those changes depend on the situation.

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 DependentsEmployees 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.
Late EnrolleesEmployees who miss the timeframe to enroll themselves or their eligible dependents for coverage must wait until the next Open Enrollment period (April/May) to enroll for coverage unless they have a mid-year qualifying life event.
Declining Medical CoverageEmployees can decline coverage as new hires, with a qualifying life event, or during Open Enrollment (April/May). Once coverage has been declined, employees can only enroll themselves or their eligible dependents for coverage during Open Enrollment unless they have a qualifying life event.
Declining Dependent Dental CoverageOnce dependent dental coverage has been declined as a new hire or upon adding a new dependent, it can only be added during Open Enrollment without a qualifying life event.
Open EnrollmentAnnual open enrollment is the only time that employees may enroll/decline coverage, switch medical plans, change their Premium Only Plan elections or enroll in the FSA. Open enrollment is usually held the last week of April and first two weeks of 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.


 

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