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: 801-366-7555 |
| : 800-765-7347 |
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As a new employee, how long do
I have to enroll in the medical and/or dental plans offered
through PEHP by my employer? |
You have 60 days from the date you are employed
to enroll yourself and your eligible dependents.
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How do I enroll in the medical
and/or dental plans? |
To enroll in PEHP’s medical and/or dental
plans you must complete the enrollment form and return it to
your Human Resource Department. Enrollment forms may be obtained
from your Human Resource Department.
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Who is eligible to be on the
health plans? |
- Your lawful spouse
- Unmarried children or step children up to the
age of 26 with whom you have a parental relationship.
- Unmarried legally adopted children, foster children,
and children through legal guardianship up to the age of 26 subject
to PEHP receiving adequate legal documentation.
- Unmarried children age 26 or older who are incapable
of self-support because of mental or physical handicap for as long
as they remain totally disabled, subject to your continued coverage.
Periodic medical documentation is required.
- Dependent children for whom you are
required to provide health insurance as stipulated in a divorce
decree. Your ex-spouse and/or stepchildren can no longer be
covered under the group plan, but may be eligible to convert
to a COBRA plan (if the employer has 20 or more employees)
or Utah State Extension of Benefits (if under 20 employees).
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Will I have a pre-existing
condition waiting period? |
The PEHP medical plan that your employer
has selected, has a nine month pre-existing condition exclusion
period. If, prior to enrolling in PEHP, you have had health insurance
coverage without a lapse in coverage of 63 days or more, your prior
coverage may be used to reduce your nine month pre-existing condition
exclusion period by the amount of time you were covered under your
previous insurance coverage. For example, if you were covered under
your previous insurance plan for nine months or longer you would
not have a pre-existing exclusion period, however, if you were
covered for only five months under your previous insurance plan
you would then have a four month pre-existing exclusion period.
When enrolling, PEHP will require a Certificate of Credible Coverage
from your previous provider of health insurance. Without the Certificate
of Credible Coverage, new enrollees may be subject to the full
nine-month pre-existing condition exclusion period.
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If I decline medical and/or dental coverage
during my initial eligibility period because of other medical
and/or dental coverage and subsequently lose my medical and/or
dental coverage do I have to wait until the annual enrollment
period to enroll in PEHP’s medical and/or dental plans?
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If at the time of enrollment you are declining
enrollment for you or your eligible dependents (including your
spouse) because of other health insurance coverage and then subsequently
lose the other coverage, you may enroll yourself and your dependents
in PEHP, provided you request enrollment within 60 days after
your other coverage ends. If you choose to terminate your other
health insurance coverage, you will not be allowed to enroll
in the PEHP medical and/or dental plans until the annual open
enrollment.
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How long do I have to report
a change in family status (i.e., divorce, birth, adoption, marriage)
to PEHP? |
You have 60 days from the change in
family status to enroll any new dependent(s). If the change is not
reported within 60 days you will have to wait until the next annual
enrollment period in order to enroll the new dependent(s). Please
note: It is the subscriber’s responsibility to notify PEHP when
a dependent is no longer eligible. PEHP cannot refund payments made
for ineligible dependents. In addition, if PEHP is not notified in
writing that a dependent is ineligible and subsequent claims are paid,
the subscriber will be held responsible to reimburse PEHP for the
claims processed beyond eligible service dates.
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How long can my dependent
children remain on my medical and/or dental policy? |
An unmarried dependent child may remain on PEHP’s
medical and/or dental policy until they reach age 26.
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May dependents under age 26 who are removed from coverage due to marriage or military duty be reinstated upon divorce or discharge from the military? |
A dependant child who marries and subsequently
divorces may not be added back onto your PEHP medical and/or dental
plan. A dependant who is discharged from the military prior to age 26
may be added back to your medical and/or plan within 60 days from the
date of discharge.
Under the dental policy anyone who is dropped from
the plan will have to wait three years until they may enroll again
and it must be done during the annual enrollment period. Back to Top
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May I add my parents, who are dependent upon me for support to my health plans? |
A parent or parents who are dependent upon you
for support may not be added to your PEHP policy.
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If my employment terminates,
how can I continue coverage? |
A federal law, the Consolidated Omnibus Budget
Reconciliation Act of 1985 "COBRA,” requires that
employers (with 20 or more employees) sponsoring group medical
and/or dental plans offer employees and their eligible dependents
that have elected coverage temporary extension of their medical
and/or dental coverage. You are responsible for the total monthly
rate plus 2%.( PEHP administers COBRA coverage in accordance
with Federal Law, 42U.S.C. Section300bb-1et.seq.)
The Utah mini-COBRA is applicable if your employer has less than 20
employees. You and your eligible dependents that have had medical
and/or
dental coverage for at least 6 months prior to your termination
date can continue your coverage for a period of six months.
You are responsible for the total monthly rate plus 2%.( PEHP
administers
Utah mini-COBRA coverage in accordance with State
Law, Utah Code Annotated. Section 31A-22-722).
Please refer to
the
PEHP Master Policy for more detailed information.
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