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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 and/or dental plans offered through
PEHP by my employer? |
If you are eligible for medical and/or dental
benefits under PEHP through State of Utah, you must enroll in
medical and/or dental coverage within 60 days from your date
of hire. Otherwise, you must wait until the next open enrollment
period.
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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 and sign the applicable enrollment form and
return
it to your department’s Human Resource personnel. Enrollment forms
may be obtained from the State of Utah Human Resource Department
or
through your agency.
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Who is eligible to be on the
medical and/or dental 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.
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Will I have a pre-existing
condition waiting period? |
The State of Utah’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 insurance plan for nine months or
longer you would not have a pre-existing exclusion period, however,
if you were covered for only six months on your previous insurance
plan you would then have a three month pre-existing exclusion
period. When enrolling, PEHP will require a Certificate of Credible
Coverage from your previous insurance plan. 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
and prosthodontics (crown, bridges, dentures).
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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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The State of Utah’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 eligible dependents because of other health insurance coverage
and then subsequently lose the other coverage, you may be able
to 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, you will not
be allowed to enroll in the PEHP medical and/or dental plans
until the annual open enrollment.
Dental coverage can only be enrolled in during
the annual enrollment period regardless if other coverage is lost.
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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.
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May I add my parents, who
are dependent upon me for support to my health and/or dental 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 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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