Recommended New Hire / Orientation Material
Next Plan Year:
All resource documents have been developed by OGI for agencies to use in conjunction with and/or to include in new hire/orientation packets.
Self Pay Forms
Retiree forms MUST be submitted directly to the Office of Group Insurance.
Dependent Eligibility Verification (DEV)
Dependent Eligibility Verification (DEV) is required when an employee enrolls a dependent on one of the State’s group medical plans (Point of Enrollment) to provide documentation that those dependents meet the eligibility criteria. Upon receipt of the enrollment notification from Blue Cross, HMS Employer Solutions will generate an “incident” and notify the affected employee by email AND hard copy letter with the instructions to complete the process.
Employees MUST include a VALID email address that they check FREQUENTLY when completing their medical/dental enrollment application. This email address will be used in combination with their home mailing address for official communication from HMS about the verification process.
Enrollment for Agencies on the SCO Payroll System
Employees must use the online medical/dental and pre- or post-tax withholding (Premium Only Plan) enrollment program on the Employee Self Service application of the State Controller’s Office website. If an employee needs assistance with their login or password for the Self Service application, please direct them to contact the State Controller’s Office. Agencies are responsible for providing their employees with online enrollment instructions.Enrollment for Non SCO Payroll Agencies
Contact the Office of Group Insurance for all enrollment forms.
Life Insurance Forms
Updated forms with email address fields are in development and will be posted as soon as they are available.
- Basic Life Beneficiary Designation and VTL Initial Election Form
- UTMA Beneficiary Designation
- Voluntary Term Life (VTL) Enrollment Form
- State Police Optional Life Insurance Enrollment Form
Employees must complete a Life Insurance enrollment/beneficiary designation forms. Each agency’s human resource office should maintain all life insurance forms in employee personnel files until such time that either a disability or life insurance claim is filed.
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FAQs – When an Employee…
|Coverages||What Action is Necessary|
|Medical, Dental and Premium Only Plan (POP)||
To continue coverage, employees must submit updated enrollment forms to reflect the employing agency change. Employees who transfer from one agency to another cannot change from one medical plan to another, nor change their pre- or post-tax Premium Only Plan elections.
Employees who previously declined dependent dental coverage cannot obtain it until the next open enrollment period.
|Flexible Spending Account (FSA) Contributions||Employees must continue their FSA elections when they transfer agencies. An updated election form must be submitted, so that the plan administrator is aware of the change in employing agencies and can properly account for payroll contributions.|
|Basic Life & Voluntary Term Life (VTL)||Your agency is responsible for obtaining life insurance enrollment/beneficiary designation forms from the previous agency and ensuring that the appropriate premium deductions occur.|
EFFECTIVE DATES FOR TRANSFERRING EMPLOYEES
- If an employee transfers out of an agency between the 1st and the 14th of a month, that agency will continue to pay applicable employer premiums through the end of that month. Starting the 1st day of the next month, the new agency will begin to pay premiums for the employee’s coverage.
- if an employee transfers out of an agency between the 15th and the last day of a month, that agency will continue to pay applicable employer premiums through the end of the following month. The new agency will begin to pay premiums as of the 1st day of the month after that.
Leave and Self Pay Flow Chart [PDF] – this document provides a generalized overview for leave and self pay situations. For questions about specific circumstances, contact OGI.
|Type of Leave||What Action is Necessary|
|Leave Without Pay (LWOP)||
While on authorized LWOP, employees may elect to continue medical, dental, Basic Life, Voluntary Term Life and State Police Optional Life coverages for up to six (6) months (twelve  months for authorized employer-sponsored leave for professional and educational purposes). To continue coverage, employees must self-pay the total monthly premium, including the state contribution, for each continued plan.
Employees self-pay by sending your agency monthly checks or money orders made payable to the Office of Group Insurance. Cash payments are not accepted. You in turn will need to complete the appropriate Self-Pay Reporting Form and send it to OGI along with all self-pay checks attached, no later than the fifth (5th) of the month for which the payment applies.
After reaching the maximum LWOP self-pay period, employees may continue medical and/or dental for a period of time under COBRA and apply for conversion of life insurance coverages to individual policies.
|Family and Medical Leave Act (FMLA)||
While on approved FMLA leave, employees may continue medical, dental, Basic Life, Voluntary Term Life and State Police Optional Life coverages.
To continue coverage, employees must pay their share of the monthly premiums and your agency must continue to pay all employer premiums. Employees who continue to receive paychecks while on FMLA pay their share of the premiums through payroll deductions. Employees who are not receiving paychecks while on FMLA must self-pay their share of premiums by sending monthly checks or money orders to you, made payable to the Office of Group Insurance. Cash payments are not accepted. You in turn will need to complete the appropriate Self-Pay Reporting Form and send it to OGI along with all self-pay checks attached, no later than the fifth (5th) of the month for which the payment applies.
When FMLA ends, employees who continue to be on approved leave without pay may continue coverage for the balance of the six (6) month LWOP period by self-paying the total monthly premium, including the State contribution. After reaching the maximum LWOP self-pay period, employees may continue medical and/or dental for a period of time under COBRA and apply for conversion of life insurance coverages to individual policies.
For the first six (6) months of military leave, employees may continue coverage for themselves and their eligible family members the same as described for Leave Without Pay. However, your agency must continue to pay the employer contribution for the first thirty (30) days of the employee’s leave.
After the six (6) month LWOP period ends, employees may continue medical and dental coverages for themselves and dependents under COBRA. Basic Life and Voluntary Term Life may be converted to individual policies.
|Disability||Employees who become disabled may continue their group insurance coverages for a period of time. OGI provides disabled employees with a detailed explanation of options including what’s available and how long benefits may continue.|
If employees continue their group insurance coverages while on leave of absence, those coverages will resume when they return to work but re-enrollment may be required. If coverage lapses during the leave, employees may have the option to resume participation when they return. The rules for resuming coverage differ depending on the kind of leave.
RESUMING COVERAGE AFTER LEAVE
|Coverages||What Action is Necessary|
|Medical and Dental Coverage||
To resume coverage, returning employees can re-enroll themselves and eligible family members in the same plans in which they were enrolled before they went on leave. Please contact our office for re-enrollment instructions specific to employees returning from military leave.
State-paid coverage is effective the first (1st) of the month following the date the new enrollment form is submitted (or immediately when returning from military leave, provided the new enrollment form is completed within thirty  days).
If employees allowed their coverage to lapse while they were on LWOP, all contract provisions, including new annual deductibles, out-of-pocket maximums and waiting periods, will apply the same as for new enrollees.
For employees returning from military leave, participation will resume at the same status in which they left. This means, for example, that the time an employee was covered before the leave will count toward satisfying medical plan waiting periods for pre-existing conditions; and, if the employee returns within the same plan year as the leave began, any amounts he or she paid for covered expenses before the leave will still count toward satisfying that year’s medical or dental plan deductibles or out-of-pocket maximums.
For employees who previously declined dependent dental coverage, the declinations remain in effect when they return from leave.
|Basic Life||To resume this coverage, returning employees don’t have to do anything. If they’re eligible, coverage begins automatically the day they return to active status; you will need to ensure the appropriate premium payments resume.|
|Voluntary Term Life (VTL) and State Police Optional Life||
If coverage did not lapse, no re-enrollment is necessary but you will need to ensure that premium deductions resume. If the employee allowed coverage to lapse, you will need to ensure that the premium deduction does not resume when payroll is reactivated. If the employee wants to re-enroll, he/she must provide evidence of good health before coverage can be activated. Please refer employees to our office for assistance. If an application is approved, we will advise you of the effective date.
Employees returning from military leave, who allowed the policy to lapse, may resume coverage without a health statement as long re-enrollment occurs within thirty (30) days. If coverage did not lapse during military leave, no re-enrollment is necessary but you will need to ensure that the appropriate premium deductions resume.
|Flexible Spending Account (FSA) Participation||
Employees who go on leave and subsequently return within the same plan year must resume participation in the FSA. You will need to ensure that payroll deductions are activated when employees return to active status.
Employees who go on leave and do not return to work until a different plan year cannot re-enroll in the FSA unless they were on military leave. Please contact our office for re-enrollment instructions specific to employees returning from military leave.
|Coverages||What Action is Necessary|
|Medical, Vision and Dental Coverage||
In general, employees simply show their plan identification cards to providers at the time of services. The providers then bill the plans directly.
When employees are required to file claims (for example, if services are provided by a non-participating provider who will not bill insurance), they send their itemized receipts and claim forms (downloadable from the carriers’ websites) directly to the applicable carrier.
|FSA Claims||Employees who elect to participate in the FSA receive claim reimbursement information from the plan administrator, Navia Benefit Solutions. Employees may elect to use an Electronic Payment Card (debit card), submit claims electronically or via hardcopy.|
|Basic Life, Voluntary Term Life (VTL) and State Police Optional Life||
When an active employee or the dependent of an active employee passes away, beneficiaries may obtain a life claim form from our office or from you. Beneficiaries must complete Parts II, III and IV of the form and return it to you along with a certified copy of the death certificate; you will need to complete Part I, attach the employee’s initial enrollment form and any subsequent change of beneficiary form(s) (if the claim is on an employee) and send everything to our office.
In the event of a Basic Life dependent claim, it is not necessary to include the enrollment/beneficiary form because the beneficiary is always the employee. If an employee is submitting a Voluntary Term Life claim on a dependent a copy of the VTL enrollment form will need to be included.
The Basic Life insurance policy also includes an “Accelerated Benefit Option” or ABO. The ABO allows a terminally ill employee with a life expectancy of twelve months or less to be paid up to half of his or her Basic Life insurance benefit prior to death. More detailed information and the necessary claim form can be obtained from our office.
To obtain a claim packet, employees, their representatives or the agency human resource office should contact the Office of Group Insurance.
If an employee files a claim, we will contact your office to obtain the employment related information necessary to process the claim.
We will also apprise each employee who files a claim what his/her options are for continuing group insurance coverages while on disability.
LOSS OF ELIGIBILITY
Employees lose eligibility when they no longer meet the plans’ definition of an eligible employee. This may happen, for example, because they terminate employment or they may become temporarily ineligible due to a reduction in hours.
Family members lose eligibility when they cease to meet the plans’ definition of an eligible dependent, for example, a dependent child reaches age 26. For detailed eligibility information refer to the Eligibility and Enrollment page.
WHEN COVERAGE ENDS
- For employees whose active status ends before the fifteenth (15th) of a month, coverage will continue through the end of that month;
- For employees whose active status ends on or after the fifteenth (15th) of a month, coverage extends through the end of the following month.
For enrolled dependents, coverage ends when the employee’s coverage ends or at the end of the month in which he/she ceases to meet the definition of an eligible dependent, whichever occurs first.
If your agency paid premiums while an employee was ineligible, contact our office to request a refund.
CONTINUING COVERAGE AFTER LOSS OF ELIGIBILITY
After their active employee coverage ends, employees have options for continuing most coverages on an individual basis for a period of time. Eligible retirees may also purchase retiree group medical coverage for themselves and their dependents; there is no retiree group dental plan.
|Coverages||What Action is Necessary|
|Active Employee Medical, Dental and FSA Coverages||After eligibility for group coverage ends, employees may be able to purchase continued medical and/or dental coverages for a period of time under COBRA. Employees may be eligible to continue their FSA medical reimbursement account on a post-tax contribution COBRA basis if their account balance exceeds their contributions when their employment ends. Please refer employees with COBRA questions to the Office of Group Insurance.|
|Life Insurance Conversion||After group coverage ends, participants in the Basic Life, Voluntary Term Life or State Police Optional Life plans may purchase conversion polices (or choose the Portability option for VTL coverage) for up to the amount of coverage in force at the time of termination. Benefits, provisions and costs of a conversion policy may differ substantially from those available under the State’s group plans. Disability coverage cannot be converted to an individual policy. Please refer employees with life insurance conversion questions to the Office of Group Insurance.|
Medical, Dental and Basic Life Premiums
You will complete the appropriate IPOPS set-up for each newly hired or eligible employee as close to the date of hire or benefit-eligibility as possible. This will ensure that Basic Life premiums are calculated and deducted appropriately and that employees have access to the online medical/dental enrollment program.
Agencies on the SCO payroll system do not set up medical/dental premium deductions, those deductions are automatically set up when an employee submits an online enrollment form. Any necessary medical/dental premium adjustments are automatically calculated by the payroll system or processed by Office of Group Insurance staff. If it is necessary for the Office of Group Insurance to process a premium adjustment manually, we will contact the employee directly to make them aware of the reason for and amount of the adjustment.
The Division of Statewide Payroll (DSP) is the payroll system within the State Controller’s Office (SCO) that most agencies use. The Division of Statewide Payroll provides a DSP Personnel/Payroll User Manual located in the payroll section of the SCO website at www.sco.idaho.gov, in which you’ll find detailed procedures for paying premiums under the SCO payroll system.
If your agency’s payroll system is outside of the SCO payroll system, contact the Office of Group Insurance for premium payment procedures.
Employees can change their current benefit elections for a variety of reasons. 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. Refer to the Eligibility and Enrollment page for detailed information.
Changing Medical and Dental Benefit Elections
|What Action is Necessary|
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 employee.idaho.gov/ 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.
|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.|
Each employee who elects this coverage pays the full premium — the cost depends on the employee’s age and benefit amount. For new hires, the agency human resource office calculates the monthly premium deduction based on the employee’s age and amount of coverage elected on the effective date of coverage. After initial enrollment, age changes are made automatically by the payroll system for all enrollees on July 1 each year.
How You Calculate VTL Premium:
When calculating deductions for employee coverage, round the employee’s annual salary up to the next higher thousand (unless salary is already an even multiple of one thousand), multiply by 1, 2 or 3 (depending on amount of coverage elected) and then multiply the resulting units of coverage by the appropriate premium rate.
For example, if an employee is 28, his annual salary is $35,210 and he elected 3x his salary in VTL coverage, you would round the salary to $36,000, multiply 36 by 3 and then multiply 108 by $.08 for a total monthly premium of $8.64.
Premiums for Spouse coverage are based on the employee’s age and that the total monthly premium for Child coverage is $2.00, regardless the number of children in the employee’s family.
Monthly VTL premiums are deducted on the first pay date of the month for current month’s coverage.
Employees can apply for Voluntary Term Life (VTL) coverage anytime. Those who apply after the thirty (30) day initial enrollment period must provide proof of insurability before enrollment can be approved. Please refer employees to the Office of Group Insurance for assistance with this process. If an employee’s application for coverage is approved, we will notify you of the effective date so that you can set up the appropriate premium deduction.
Employees may change their beneficiaries for Basic Life, Voluntary Term Life (VTL) or State Police Optional Life Insurance at any time. To do so, employees must complete a new Beneficiary Designation form and submit it to you for inclusion in their personnel files.
Declining Voluntary Term Life (VTL) Coverage
Employees may decline Voluntary Term Life coverage at any time. To do so, they must complete a new Principal Life Enrollment/Beneficiary Designation form and select the option to waive coverage.
Employees may only change elections mid-year in the event of a qualifying family status change. No other mid-year changes are allowed. To change contributions, the employee submits a revised FSA Election form indicating the new contribution amount. Employees may increase, decrease or initiate dependent care elections, but may only increase existing medical reimbursement account elections. All changes must be submitted within thirty-one (31) days of the qualifying event.
The Office of Group Insurance must review and approve any mid-year changes in FSA contributions in compliance with IRS rules and regulations. We will notify the employee and your agency if the change has been approved.
|Coverages||What Action is Necessary|
|Retiree Medical Insurance||Currently, eligible retirees may elect coverage under the Blue Cross of Idaho PPO, Traditional or High Deductible plans. Details of the plans, including provisions and benefits, are included in the contracts posted on the Group Insurance website. Please refer any retirees with questions about coverage or enrollment procedures to our office.|
|Retiree Life Insurance||
There is no retiree Basic Life policy for the majority of retirees. However, eligible retirees from the following agencies do have coverage: Judges and Justices; Department of Labor; Idaho State University, Boise State University, Lewis-Clark State College and Eastern Idaho Technical College.
The individual agencies make the eligibility regulations, apprise their employees if they are eligible for coverage and pay the premiums to the Office of Group Insurance. Basic Life coverage for retirees can vary based on age and position.
For detailed retiree information including eligibility, premium rates and enrollment, visit the Office of Group Insurance – Retiree page.