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 due to a qualifying life event 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.

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

Qualifying Life Events

Qualifying Life Event Summary

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.

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

Marriage/Divorce
Birth or Adoption
Death
Change in coverage under other employer’s plan
Spouse loss of coverage, etc.

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.

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.

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 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	Employees 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 Coverage	Employees 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 Coverage	Once 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 Enrollment	Annual 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.