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In general, there are three times at which you may enroll/change your health care benefits:
1. Enrolling at Hire
You need to enroll by submitting a completed Enrollment Form for health care coverage to your agency within 31 days of your date
of hire or your change to permanent status. If you do not enroll within
this time frame, you must wait until the next open enrollment period. You may also enroll online using OAKS Self-Service.
Health
care coverage begins on the first day of the month following the month
in which you become eligible and submit a completed Enrollment Form or enroll using OAKS Self-Service.
2. Enrolling/Making Changes During Open Enrollment
You may enroll, add/drop dependents or change your current elections during
the open enrollment period. Open enrollment occurs at least every two years and is
usually held in the spring. Coverage becomes effective on the first day
of the next benefit period (typically July 1).
Limited Enrollment Period
During years in which there is no open enrollment, a limited enrollment period will be designated by the Department of Administrative Services. During this limited enrollment period, employees may:
- Add or remove dependents,
- Increase their supplemental life insurance amount, and
- Enroll for health, dental, vision or supplemental life insurance benefits for the first time.
Leave
of Absence
If you are on a leave of absence and coverage has not stopped, you may apply
for coverage or change of coverage during the period of open enrollment;
however, no change will become effective until the first day of the month
following your return to active work status. If you are on disability
leave or are receiving benefits from workers’ compensation,
changes you make during open enrollment will take effect at the beginning
of the next benefit period.
3. Enrolling/Making Changes Due to A Life Event
Under
normal circumstances, you cannot change or drop your coverage until open enrollment
unless you experience a qualified life event. You can only change your coverage if you submit a completed enrollment form to your agency within 31 days of one of the following
events, or - for those changes marked with an asterisk - you may make the changes online using OAKS Self-Service:
- If you move outside of your HMO's service area during the benefit year.
- *After marriage,
divorce, legal separation or annulment. Coverage becomes effective the first day of the month following the
month of application.
- *Birth, adoption or
placement for adoption, or taking custody of the child for purposes of adoption. Coverage
begins on the date of the event.
- *Commencement of employment by the employee, spouse or dependent. Coverage becomes effective the first day of the month following
the month of application.
- Termination of state service, death of the employee or death of employee's spouse. Coverage terminates the end of the month of the event. A change from family to single coverage - if desired - is effective the first of the month following the death of a spouse.
- Reduction or
increase in hours of employment by the employee (including layoff
or reinstatement from layoff), spouse or dependent, including a switch
between part-time and full-time, strike, lockout or commencement,
return to work from an unpaid leave of absence or change in worksite. Coverage becomes effective the first day of the month
following the month of the event provided a completed Enrollment Form is submitted to your agency within 31 days of the event.
- Return to work
through order of arbitration or settlement of a grievance, or any
administrative body with authority to order the return to work of
an employee.
- The employee’s
dependent satisfies or fails to satisfy the definition
of a dependent due to attainment of age, student status or any similar
circumstance as provided in the health plan under which the employee
receives coverage.
- If the plan
receives a Qualified Medical Child Support (QMED) order pertaining
to an employee’s dependent, the employee may elect to add or
drop the child to the plan depending upon the requirement of the QMED.
- If an employee,
spouse or dependent who is enrolled in a health plan becomes entitled
to coverage (i.e., enrolled) under Medicare or Medicaid, other than
coverage consisting solely of benefits under section 1928 of the Social
Security Act (the program for distribution of pediatric vaccines).
- If an employee,
spouse or dependent is no longer entitled to coverage (i.e., enrolled)
under Medicare or Medicaid.
-
The employee
no longer resides or no longer works in the service area of the employee’s
current plan.
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