|
|
|
|
|
|
|
 |
: 801-366-7555 |
| : 800-765-7347 |
|
|
|
|
|
 |
As a new employee, how long do
I have to enroll in the medical and/or dental plans offered
through PEHP by my employer? |
If you are eligible for medical and/or dental benefits,
you have 60 days from the date you are employed to enroll yourself
and your eligible dependents.
Back to Top
|
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 The
Benefits Section of Salt Lake City Corporation Human Resources.
Enrollment forms may be obtained from The Benefits Section of Salt
Lake City Corporation Human Resources.
Back to Top
|
Who is eligible to be on the
medical and/or dental plans? |
- Your lawful spouse or common law spouse (if determined
by a court; documentation is required).
- 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.
Back to Top
|
Will I have a pre-existing
condition waiting period? |
Salt Lake City Corporation’s Preferred Care health Policy
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 health
insurance plan for nine months or longer you would not have a pre-existing
exclusion period, however, if you were covered under your previous
health insurance plan for only six months you would then have a three
month pre-existing exclusion period. When enrolling, PEHP will require
a Certificate of Credible Coverage from your previous health insurance.
Without the Certificate of Credible Coverage, new enrollees may be
subject to the full nine-month pre-existing condition exclusion period.
Salt
Lake City Corporation’s Exclusive Care health Policy has no
pre-existing condition exclusion period.
Dental coverage does not
have a pre-existing condition exclusion period, however there
is no coverage for work in progress and there is a six-month
waiting
period for coverage on orthodontics.
Back to Top
|
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 the plans? |
Salt Lake City Corporation’s policy is
that an employee who is eligible for health insurance must be
enrolled.
However, if at
the time of enrollment you are declining enrollment for your dependents
(including your spouse) because of other health insurance coverage
and then subsequently lose the other coverage, you may enroll 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, your dependents will not be allowed to
enroll in the PEHP medical and/or dental plan until the annual open
enrollment.
Dental coverage
can only be enrolled in during the annual enrollment period regardless
if other coverage is lost.
Back to Top
|
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 The Benefits
Section of Salt Lake City Corporation Human Resources when a dependent
is no longer eligible. PEHP cannot refund payments made for ineligible
dependents. In addition, if The Benefits Section of Salt Lake City
Corporation Human Resources 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.
Back to Top
|
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.
Back to Top
|
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
|
May I add my parents, who are dependent upon me for support to my medical and/or
dental plans? |
A parent or
parents who are dependent upon you for support may not be added to
your PEHP policy.
Back to Top
|
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 extention 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, 42 U.S.C. Section 300bb-1 et.seg.)
Please refer to the PEHP Master Policy for
more detailed information.
Back to Top
|
|
|
