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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? |
Your employer determines how long you have to
enroll in the health plan.
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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 your Business Administrator
at the District Office. Enrollment forms may be obtain from your District
Office.
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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.
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Will I have a pre-existing
condition waiting period? |
All USBA plans have an eight 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 eight 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 another health plan for eight months or longer you
would not have a pre-existing exclusion period, however, if you were
covered for only five months on another health plan you would then have
a three month pre-existing exclusion period. When enrolling, PEHP will
require a Certificate of Disclosure Statement. Without the Certificate
of Disclosure Statement, new enrollees may be subject to the full eight-month
pre-existing condition exclusion period.
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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?
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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 enroll yourself and your dependents in PEHP,
provided you request enrollment within 60 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 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).
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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 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 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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