Enrollment

Who can enroll?

There are generally 4 circumstances when an eligible employee can enroll in benefits or make changes to their existing enrollment. Once enrolled, employees may not make changes to their benefits, except as shown below:

New Hires have 30 days to complete enrollment in benefits. Coverage begins first of the month following the date of hire. Applications submitted after 30 days, will be denied.

Newly Eligible employees, or those who become eligible for benefits due to a change in employment circumstances (e.g. employee hours changed from under 20 hours per week to 20 or more hours per week). Newly eligible employees have 30 days to complete enrollment in benefits. Coverage begins the first of the month following the date of hire. Applications submitted after 30 days, will be denied.

Open Enrollment is 3-week period that occurs once per year in the spring just prior to the new fiscal year. During the Open Enrollment period, any eligible employee may enroll in, or make changes to, their benefits. After Open Enrollment ends, changes may not be made until the next period without a Qualifying Life Event.

Qualifying Life Events occur when employees experience changes in their life situations such as marriage, divorce, birth/adoption of a child, employee or their dependent loses their coverage, a dependent gains their own coverage, or the death of a dependent. Qualifying life events allow employees to enroll or disenroll outside of the Open Enrollment period, depending on the circumstances. There are strict rules regarding the timeframes for each of the Qualifying Life Events. Be sure to review the Qualifying Life Events section and/or seek guidance from your HR contact.

How To Enroll 

For eligible employees who are in an enrollment window: 

Employees whose agencies are on the State Controller’s Office (SCO) payroll system MUST submit their Medical (includes pharmacy, vision, and EAP), Dental, Health Savings Accounts (HSA), and Flexible Spending Arrangements (FSA) enrollment electronically via Luma. 

Employees whose agencies maintain their own payroll system must complete hard copy paper forms for all coverages.  

Employees whose agencies maintain their own payroll system but use Employee Navigator, employees are required to complete enrollment in this system. 

Employees are responsible for submitting the appropriate enrollment forms and documents within the required timeframes. Incomplete or illegible applications will be rejected by the carrier and cause delays in enrollment. Employees can obtain specific enrollment information and instructions from their HR offices. 

All submitted paper enrollment forms are reviewed for accuracy by the Office of Group Insurance before they are transmitted to our insurance carriers. Incomplete or illegible applications will be rejected and returned to the agency. 

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

Disenrollment 

Times when you may only disenroll yourself or your dependents for coverage: 

During Open Enrollment, which is the last week of April and first two weeks of May every year, you may make enrollment changes that take effective July 1. 

With a Qualifying Life Event, e.g., 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. 

Dual Enrollment 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 separately; 

• Each employee can enroll for individual coverage. 

• Dependent children may only be covered under one plan.

Transferring/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. 

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/waive 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.