Open Enrollment

In the face of rising health care costs, it is important that our plans only pay appropriate claims. Paying for ineligible dependents is a price we all pay through higher monthly contributions. As a result, many employers have adopted the “best practice” of having total re-enrollments annually as well as auditing dependent eligibility.

During the open enrollment period, we are requesting all state employees to re-enroll by confirming their personal and plan coverage information as well as verifying the eligibility of their dependents. Employees will be able to re-enroll using a paper form or on-line. Employee personal, plan coverage and dependent information already is provided both online and in the paper form. During this benefit year, employees will be subject to random eligibility audits. If you are selected for this audit, you will be required to provide documentation (e.g. marriage certificate, birth certificate, etc.) demonstrating your dependents’ eligibility. Employees who do not take the time to re-enroll will have an increased chance of being audited.

What Do I Need To Do?
1) Understand who is considered an eligible dependent and who is not. (See Page 7)

2) Understand the common misconceptions regarding family members and
dependent eligibility (see below). Determine if this applies to you.

3) Update/modify the dependent information on-line or via the paper
form. Current employee personal and coverage data is provided with both
methods.

Common Misconceptions
False: Sons and daughters may remain on your health plan coverage after they graduate from college or take a year off from college.

Fact: Children 19 or older are no longer considered eligible dependents for coverage once they graduate from college or discontinue their college studies. They would be eligible for coverage under COBRA.

False: A divorced spouse can remain on an employee’s plan.

Fact: Divorced spouses can only stay on the plan if the employee pays the total cost of health care through COBRA. Once divorced, the former spouse is eligible ONLY for coverage through a timely COBRA election (i.e. within 60 days of the event). If elected timely, coverage would continue for the former spouse for up to 36 months as long as timely payments are received.

Keep Your Documentation Handy
When enrolling your family members for benefits, you are acknowledging that you have correctly reported your dependents’ eligibility status. If audited by the state or a plan carrier, you will need to show proof of eligibility. Proof of dependency includes a copy of a birth certificate, adoption paperwork, legal guardianship paperwork, a marriage certificate or current school schedule for students older than 19 and possibly the most recent tax return. Failure to provide adequate documentation may result in loss of coverage for your dependents. Listing of ineligible dependents could be considered fraud against the plan and consequences could include repayment of ineligible claims, loss of benefits and/or disciplinary action including but not limited to employment termination and/or reduction of retirement benefits.


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6 VERIFY YOUR DEPENDENTS' ELIGIBILITY	In the face of rising health care costs, it is important that our plans only pay appropriate claims. Paying for ineligible dependents is a price we all pay through higher monthly contributions. As a result, many employers have adopted the “best practice” of having total re-enrollments annually as well as auditing dependent eligibility. During the open enrollment period, we are requesting all state employees to re-enroll by confirming their personal and plan coverage information as well as verifying the eligibility of their dependents. Employees will be able to re-enroll using a paper form or on-line. Employee personal, plan coverage and dependent information already is provided both online and in the paper form. During this benefit year, employees will be subject to random eligibility audits. If you are selected for this audit, you will be required to provide documentation (e.g. marriage certificate, birth certificate, etc.) demonstrating your dependents’ eligibility. Employees who do not take the time to re-enroll will have an increased chance of being audited. *What Do I Need To Do?* 1) Understand who is considered an eligible dependent and who is not. (See Page 7) 2) Understand the common misconceptions regarding family members and dependent eligibility (see below). Determine if this applies to you. 3) Update/modify the dependent information on-line or via the paper form. Current employee personal and coverage data is provided with both methods. Common Misconceptions False: Sons and daughters may remain on your health plan coverage after they graduate from college or take a year off from college. Fact: Children 19 or older are no longer considered eligible dependents for coverage once they graduate from college or discontinue their college studies. They would be eligible for coverage under COBRA. False: A divorced spouse can remain on an employee’s plan. Fact: Divorced spouses can only stay on the plan if the employee pays the total cost of health care through COBRA. Once divorced, the former spouse is eligible ONLY for coverage through a timely COBRA election (i.e. within 60 days of the event). If elected timely, coverage would continue for the former spouse for up to 36 months as long as timely payments are received. Keep Your Documentation Handy When enrolling your family members for benefits, you are acknowledging that you have correctly reported your dependents’ eligibility status. If audited by the state or a plan carrier, you will need to show proof of eligibility. Proof of dependency includes a copy of a birth certificate, adoption paperwork, legal guardianship paperwork, a marriage certificate or current school schedule for students older than 19 and possibly the most recent tax return. Failure to provide adequate documentation may result in loss of coverage for your dependents. Listing of ineligible dependents could be considered fraud against the plan and consequences could include repayment of ineligible claims, loss of benefits and/or disciplinary action including but not limited to employment termination and/or reduction of retirement benefits.