Eligibility

Q:  Do I need to complete an Enrollment/Change Form to enroll new dependents?

A:  Yes, and employees must enroll any new dependents within 31 days of the date of birth.

Q:  What are the qualifying events that would allow me to enroll under my employer's group health plan if I were to lose coverage through another group health plan or health insurance coverage?

A:  A qualifying event has occurred when coverage is terminated as result of the following: loss of eligibility for coverage (including loss of eligibility for coverage as a result of legal separation, divorce, death, termination of employment or reduction in the number of hours of employment); or employer contributions toward such coverage were terminated; or the exhaustion of COBRA coverage if elected following such loss of eligibility under the other group health plan or health insurance coverage. However, see your Summary Plan Description for a full list of qualifying events that may be applicable to you.

Q:  How are employer's notified of ineligible dependents? 

A:  An employee must notify his/her employer of any dependent no longer meeting the eligibility requirements of the "Plan". If the employer is not notified within 60 days of the date the dependent loses eligibility status, the employer is not obligated to offer COBRA.

Q:  What happens to claims for prescription drugs when my participation in the health plan terminates? 

A:  Coverage is terminated under the Plan until such time that the Qualified Beneficiary properly elects COBRA coverage and makes the applicable premium payment. If you have paid for a claim incurred after your Qualifying Event, in this case termination date, you can submit your receipt for reimbursement once you have returned your signed election form and paid all premiums due through the present date in a timely manner.

Once you have elected and paid for COBRA, claims will only be processed through the date your coverage is paid.

Q:  Whom can I put on this plan?

A:  Please review the Eligibility section of your medical Summary Plan Description.

Q:  What if my dependents have other coverage? 

A:  Please review the Coordination of Benefits section of your medical Summary Plan Description.

Q:  Can I provide coverage for my child who is a full-time student in college? 

A:  Please review the Eligibility section of your medical Summary Plan Description.

Q:  What documentation will I need to show full-time student status?

A:  We do not require documentation from the school. We do however, require the school name and number and written verification from the employee that the child is attending an accredited school full-time and meets the other eligibility requirements of the plan.

Q:  Who is an eligible employee?

A:  An eligible employee is an employee who meets the definition in the plan for participation. Definitions of eligible employee vary widely from employer to employer, though they may be influenced by legal considerations and company structure.

Q:  What is the purpose of completing the Coordination of Benefits/Yearly Other Insurance Update? 

A:  Many people have changes in their coverages from year to year, this form helps us have the most up-to- date information in our system.

Q:  Can I give other insurance information over the phone?

A:  For auditing purposes, we ask that you send the forms back to us. A return envelope is provided along with the letter.
 

Q:  If any family members have other insurance that will be terming, or has already termed, what should I do?

A:  Refer to your Human Resources Benefits Department to request a change in your Coordination of Benefits. You should also consult with the Plan Sponsor of the coverage that is terminating regarding COBRA rights.