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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 plan offered through PEHP by Nebo
School District? |
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
plans offered through PEHP by Nebo School District? |
To enroll in PEHP’s medical 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
medical plan? |
- 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 your employer has less
than 20 employees.)
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Will I have a pre-existing
condition waiting period? |
Nebo School
District has a six 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 six 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 six 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 one 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 six-month pre-existing condition
exclusion period.
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If I decline PEHP medical coverage during
my initial eligibility period because of other medical coverage
and subsequently lose my medical coverage do I have to wait
until the annual enrollment period to enroll in the PEHP
medical plan?
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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 health insurance coverage ends If you choose to terminate
your other health insurance coverage, you will not be allowed
to enroll in the PEHP medical plan 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. All enrollment
forms and changes in family status must be turned into Nebo School
District's Human Resource Department.
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How long can my dependent
children remain on my medical policy? |
An unmarried dependent child may remain on PEHP’s
medical 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.
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May I add my parents, who
are dependent upon me for support to my medical 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.)
Please refer to the PEHP Master Policy for more detailed information.
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