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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 health plans offered through
PEHP by my employer? |
If you are eligible for health insurance benefits
under PEHP through Salt Lake County, you must enroll in coverage within
60 days from your date of hire.
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How do I enroll in the health plans? |
To enroll in PEHP’s health insurance plan you
must complete the enrollment form and return it to Salt Lake County
Personnel. Enrollment forms may be obtain from Salt Lake County Personnel.
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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).
- One adult designee. Adult designees are eligible on your plan
if you both: are unmarried and over age 18, share a close, personal
relationship, have a jointly shared permanent residence, and have
interdependent financial obligations.
- Unmarried children or step children up to the
age of 26 with whom you have a parental relationship.
- Unmarried children or step children up to the
age of 26 with whom your adult designee has 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.
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Will I have a pre-existing
condition waiting period? |
Salt Lake City Corporation's Summit Care and Advantage Care plans
do not have a pre-existing condition exclusion periods.
Salt Lake City Corporation's Preferred Care plan has a nine-month pre-existing
condition exclusion period that can be waived with evidence of prior credible
coverage. 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.
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.
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.
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If I decline health coverage
during my initial eligibility period because of other health coverage
and subsequently lose my health coverage do I have to wait until
the annual enrollment period to enroll in the plans? |
If at the time of enrollment you are declining
enrollment for you or your dependents (including your spouse) because
of other health insurance coverage and then subsequently lose the
other coverage, you may be able to enroll yourself and your dependents
in PEHP, provided you request enrollment within 30 days after your
other coverage ends.
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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 30 days from the change in family status
to enroll any new dependent(s). If the change is not reported within 30 days you will have to wait until the next annual enrollment
period in order to enroll the new dependent(s).
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How long can my dependent
children remain on my health policy? |
A dependent child may remain on the health 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 and/or dental plans?
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You may add a dependent parent only if he or she qualifies as your adult designee.
Adult designees are eligible on your plan if you both: are unmarried and over age
18, share a close, personal relationship, have a jointly shared permanent residence,
and have interdependent financial obligations.
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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 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.
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