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Employee Insurance Education Part #1. Introduction and Eligibility.

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Presentation on theme: "Employee Insurance Education Part #1. Introduction and Eligibility."— Presentation transcript:

1 Employee Insurance Education Part #1

2 Introduction and Eligibility

3 The information in this overview is not meant to serve as a comprehensive description of the benefits offered by the Employee Insurance Program. Have your Insurance Benefits Guide and literature from the various HMOs handy as you read through this presentation for additional information. Important Information for Employees

4 Employee Classified as permanent and full- time Works at least 30 hours per week Works at least 20 hours per week  Employer has option to request to enroll this type of employee  Decision irrevocable after EIP approval Eligibility

5 Retiring Employee Must meet SCRS, GARS, JSRS or PORS eligibility criteria for retirement Last five years of service must be full-time, permanent and consecutive, with employer participating in state’s insurance benefits programs Eligibility

6 Dependent Spouse Wedded spouse or common- law spouse (cannot be employed by state insurance participating employer) Ex-spouse if coverage is court-ordered (by divorce decree) Eligibility

7 Children Under 19, or until age 25, if a full-time student Unmarried children  Natural child  Stepchild  Adopted or foster child  Child for which subscriber has legal custody Eligibility

8 (cont.) Children not employed with benefits Child that resides with employee or employee’s child by court order Child who is principally dependent on subscriber for more than 50 percent of time Child approved for incapacitation Eligibility

9 Additional Documentation Incapacitated child Adopted child Student certification, age 19 to 25 Employee’s child who resides outside home (under court-order to cover child) Common-law spouse or ex-spouse by court order Eligibility

10 Survivors Insurance Education Part #1

11 Eligibility Dependent must be covered at time of death to be classified as survivor If coverage terminated, survivor cannot return to survivor coverage Survivors

12 Premiums Can continue coverage after one-year waiver but must pay full cost of health premium Following one-year premium waiver, survivors of employees killed in line of duty may continue health and dental insurance coverage at employer-funded rate * Survivors

13 Health Insurance Premium waived for one year * Spouse eligible until remarried Children eligible if classified as eligible dependents Dental Insurance No premium waiver Spouse eligible until remarried Children eligible if classified as eligible dependents Survivors

14 Eligibility and Coordination of Benefits Insurance Education Part #1

15 Within 31 days of hire date Within 31 days of special eligibility situation  Marriage, birth, adoption or placement of child for adoption  Involuntary loss of coverage During open enrollment period (will be enrolled as late entrant) Enrollment: Employees and Dependents Eligibility and Coordination of Benefits

16 Enrollment Guidelines: Employees and Dependents State-offered health and dental insurance plans coordinate benefits with other coverage Parent whose birthday occurs earliest in year (for both parents) is primary for dependents covered by both parents Eligibility and Coordination of Benefits

17 Terminations and COBRA Continuation Of Coverage Insurance Education Part #1

18 Ineligible Spouse Spouse may remain on coverage until he/she becomes ineligible (with divorce) Divorce (unless coverage court- ordered) Death Gains state insurance coverage Terminations and COBRA

19 Ineligible Dependent Children Child marries Child becomes employed with benefits Child turns 19, unless full-time student or approved for incapacitation Terminations and COBRA

20 When to Offer COBRA Employee must meet group plan’s definition of eligibility to participate in group health plan Child turns 25, unless approved for incapacitation Terminations and COBRA

21 (cont.) When qualifying event occurs, COBRA offered to eligible participants enrolled in a group health plan  State health plans  HMOs  State dental plans  MoneyPlu$ Medical Spending Account Terminations and COBRA

22 (cont.) Employee may continue coverage for 18 months if he/she:  Leaves employment, terminated or terminated as a result of RIF (reduction in force)  Has hours reduced Terminations and COBRA

23 (cont.) If approved for Social Security disability within first 18 months of COBRA continuation coverage, Employee may extend coverage up to 29 months, provided COBRA notification rules are followed Terminations and COBRA

24 Dependents who become ineligible may continue coverage for 36 months if ineligibility is reported within 60 days of date of qualifying event (cont.) Terminations and COBRA

25 Pre-existing Condition Period Insurance Education Part #1

26 Applies to: State Health Plan HMOs and Point of Service plans Basic Long Term Disability plan Supplemental Long Term Disability plan Does not apply to: State Dental Plan Life Insurance plan Health plan carrier change (if pre- existing previously satisfied) Long Term Care plan Pre-existing Condition Period

27 Definition Condition for which medical advice, diagnosis, care or treatment was recommended or received during six months preceding subscriber’s enrollment date on plan Benefits not payable until 12 months after enrollment date (18 months for late entrant) Pre-existing Condition Period

28 May reduce pre-existing period for health insurance by providing certificate of creditable coverage from subscriber’s previous insurance plan Creditable Coverage Pre-existing Condition Period

29 Pre-existing period can be reduced by number of months subscriber was insured as long as:  Prior coverage was continuous and  Any break in coverage did not exceed 62 days (cont.) Pre-existing Condition Period

30 Benefits Enrollment Periods Insurance Education Part #1

31 Annual Enrollment Period October: even-numbered years (2008, 2010, etc.) May make:  Health plan carrier changes  MoneyPlu$ changes  Life Insurance changes (with medical underwriting) Benefits Enrollment Periods

32 May make health and dental plan changes MoneyPlu$ changes Life Insurance changes (with medical underwriting) Open Enrollment Period October: odd-numbered years (2009, 2011, etc.)  May enroll as late entrant  May add or drop coverage  May add or drop dependents Benefits Enrollment Periods

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