Enrollment

Enrollment

Declining medical coverage
Cost of coverage
When coverage begins and ends
Certificate of creditable coverage
If you are not actively at work
Making changes

  

Health care coverage is not automatic—you must enroll to cover yourself and your dependents. Medical, dental and vision coverages require separate elections. You will have the ability to enroll through the online New Hire Onboarding system within 30 days of the date you first become eligible for medical plan coverage. If you do not enroll within 30 days, you will need to wait until the next annual Open Enrollment to make your benefit elections.

If you participate in a Company medical plan, you may print a temporary medical ID card by logging on to Anthem's website.

After you enroll, you will receive ID cards for the medical and dental plans. Your ID cards include important phone numbers. Please replace any old ID cards with the new ones you receive. You will need to show your ID card each time you or your covered dependents receive care from network providers. Other health care providers may also ask to see your ID card. You should carry your ID cards at all times.

The Company wants you to have at least a basic level of protection. If you don't enroll within the first 30 days of your hire date, you will be covered by the following default health care coverages:

DEFAULT HEALTH CARE COVERAGE	WHO PAYS THE COST
The CDHP Basic (this includes coverage for prescription drugs and mental health/substance abuse services)—single coverage only	The Company and you
The Vision Plan—single coverage only	The Company and you
The Dental Plan—single coverage only	The Company and you
WorkLife Services and EAP (Consultation, Referrals, and the EAP)-all eligible family members	The Company

If you do not elect coverage for yourself or your eligible dependents within 30 days after your eligibility date, you may enroll only during a future Open Enrollment period, unless you have a status change during the year. For a description of status changes, please see Making Changes. Your coverage will be effective from the date of acceptance.

  

Declining Medical Coverage

To decline medical coverage, you must have coverage through another source, such as your spouse's employer's plan. If you are declining medical coverage, you must sign a waiver stating that you have other coverage.

You may in the future be able to enroll yourself or your dependents in this plan, provided you request enrollment within 31 days after your other coverage ends.

If you gain a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents, provided that you enroll within 31 days after the marriage, birth or adoption (or placement for adoption).

  

Cost of Coverage

You and the Company share the cost of health care coverage; however, the Company pays the major portion of the cost. Your share of the cost for prescription drug and mental health/substance abuse coverage are automatically included in your medical plan contribution. Dental and vision are deducted separately. Your contribution is made through automatic payroll deductions. Any changes in the cost will be communicated to you before they are made.

In general, your contributions are made on a before-tax basis. That means they will be deducted from your regular paycheck before federal and Social Security taxes are taken—so, you pay lower taxes. In many cases, you also pay no state or local taxes on your contribution.

  

Imputed Income for Non-Tax Dependents

The Internal Revenue Code provides that only individuals who qualify as a tax dependent be provided-tax-favored benefits. If you cover a domestic partner or child who does not meet IRS criteria for tax-favored benefits, you will be taxed on the value of the benefits provided by the Company to these dependents. This means your taxable pay will be increased by the estimated value of your domestic partner’s coverage, less the amount you pay in premiums. Your taxable income will be higher than your real cash wages, and all income-based taxes will be due on the whole amount. The amount of the imputed income can be substantial and will vary by the plan you select and the number of dependents you cover. In addition, your contributions for their benefits must be paid on an after-tax basis.  

If your domestic partner qualifies for tax-favored benefits under state or federal guidelines, you must provide a completed Declaration of Domestic Partnership or Civil Union and a Declaration of Same-Sex Spouse, Domestic Partner, or Civil Union Partner’s Tax Status, if applicable to receive favorable tax treatment. 

Depending upon state law, the value of coverage for adult children who are not your federal tax dependents may be taxable to you as imputed income under state tax rules.  

  

When Coverage Begins and Ends

Once Human Resources receives your properly completed enrollment through the online New Hire Onboarding system, coverage will begin on your date of hire. A newly eligible spouse/domestic partner is effective on the date you enroll him or her for coverage, provided you enroll your spouse/domestic partner within 31 days of his or her eligibility.

A newborn is covered from birth if you enroll the baby within 31 days after the date he or she is born. An adopted child is covered from the date the child is placed with you for adoption, provided you request coverage within 31 days of the adoption. If you request coverage for a child as a result of a Qualified Medical Child Support Order (QMCSO), coverage will begin on the effective date of the court order, as long as you have notified the Company in writing of the court order and enrolled within 31 days of receiving the QMCSO.

Coverage for you and your dependents under the Company benefits program generally ends on the latest of:

• The last day of the month in which your employment ends
• The last day of the month in which you retire (if you retire before you are eligible for Medicare benefits, you may elect to continue coverage under your Company health benefits for a specified period, at your own expense (see Continuation of Coverage)
• The last day of the month in which you or your dependents no longer meet the eligibility requirements as described in Who's Eligible
• The last day of the month Anthem receives written notice from the Company to end your coverage, or the date requested in the notice if later
• The date the group plan terminates
• The date the plan determines that you committed a fraudulent act or intentional misrepresentation of a material fact including, but not limited to, false information relating to another person's eligibility or status as a dependent
• The date the plan determines that there is a material violation of the terms of the plan
• The date the plan determines that you fail to make any required contribution
• The date the plan determines you permit an unauthorized person to use your ID card or you use another person's ID card
• The date the plan determines that you physically or verbally threaten representatives of the Company or Anthem, a provider, or other persons who are covered by the plan

If you die while you are an active employee, or while receiving Short Term or Long Term Disability benefits, coverage for your dependents may continue free of charge to the last day of the month following the date of your death. After this period, your eligible dependents may elect to continue coverage at their own expense for a specified period of time (see Continuation of Coverage).

  

Extended Coverage for Full-Time Students

Coverage for an enrolled dependent child who is a full-time student at a post-secondary school and who needs a medically necessary leave of absence will be extended until the earlier of the following:

• One year after the medically necessary leave of absence begins
• The date coverage would otherwise terminate under the plan

Coverage will be extended only when the enrolled dependent is covered under the plan because of full-time student status at a post-secondary school immediately before the medically necessary leave of absence begins.

Coverage will be extended only when the enrolled dependent's change in full-time student status meets all of the following requirements:

• The enrolled dependent is suffering from a serious sickness or injury
• The leave of absence from the post-secondary school is medically necessary, as determined by the enrolled dependent's treating physician
• The medically necessary leave of absence causes the enrolled dependent to lose full-time student status for purposes of coverage under the plan

A written certification by the treating physician is required. The certification must state that the enrolled dependent child is suffering from a serious sickness or injury and that the leave of absence is medically necessary.

For purposes of this extended provision, the term "leave of absence" shall include any change in enrollment at the post-secondary school that causes the loss of full-time student status.

  

Certificate of Creditable Coverage

If your coverage under this plan stops, you and your covered dependents will receive a certificate of creditable coverage that shows your period of coverage under the plan. You may need to furnish the certificate if you become eligible under another group health plan if it excludes coverage for pre-existing conditions. You may also need the certificate to buy, for yourself or your family, an individual insurance policy that excludes pre-existing conditions. You and your dependents may also request a certificate within 24 months of losing coverage under this plan. 

  

If You Are Not Actively at Work

There may be times when your coverage may continue even if you are not actively at work.

If a you have a total disability on the date your coverage under the plan ends, your benefits will not end automatically. The plan will temporarily extend coverage, only for treatment of the condition causing the total disability. Benefits will be paid until the earlier of:

• The total disability ends; or
• Twelve months from the date coverage would have ended.

If you are on an approved leave of absence, coverage for you and your dependents may continue for the approved period, as long as you make the required contribution. (When a leave qualifies as a family or medical leave, the plan will be administered under the provisions of the Family and Medical Leave Act.) When coverage stops, you and any eligible dependents may elect to continue health care coverage for a specified period, provided you make the required contribution (see Continuation of Coverage).

  

Making Changes

Each year during the Open Enrollment period, you will be able to change coverage, including adding or dropping dependents and changing between medical plans.

You may generally change your health care coverage during the year only if you have a change in your status as defined by federal regulations. The following events qualify as a change in your status:

• Marriage, divorce, legal separation, or annulment
• Formation or dissolution of a domestic partnership
• Birth, adoption, placement for adoption, or legal guardianship of a child
• A change in your spouse's employment or involuntary loss of health coverage (other than coverage under the Medicare or Medicaid programs) under another employer's plan
• Loss of coverage due to the exhaustion of another employer's COBRA benefits, provided you were paying for premiums on a timely basis 
• Death of a dependent
• Your dependent child no longer qualifying as an eligible dependent
• A change in your or your spouse's position or work schedule that impacts eligibility for health coverage
• Employer contributions for coverage have stopped
• You move out of an HMO's service area that you are enrolled in and no other benefit option is available
• Benefits are no longer offered for a class of individuals that include you and your dependents
• Termination of your or your dependent's Medicaid or Children's Health Insurance Program (CHIP) coverage as a result of loss of eligibility (you must contact Human Resources within 60 days of termination)
• You or your dependent become eligible for a premium assistance subsidy under Medicaid or CHIP (you must contact Human Resources within 60 days of determination of subsidy eligibility)
• A strike or lockout involving you or your spouse/domestic partner
• A court or administrative order

Unless otherwise noted above, all changes must be made within 31 days of the event and supporting documentation is required. Your coverage change will be effective on the date you notify the Plan Administrator, unless your status change is a birth, adoption, or placement for adoption of a dependent child, in which case coverage will be effective retroactive to the date of the event. Any change you make must be consistent with the change in your status. For example, if you get married, you may add your spouse to your coverage. However, you may not switch from one medical plan to another until the annual enrollment period.

  

Your Special Enrollment Rights

In certain situations, you may be eligible to enroll in a health care plan during the plan year, even if you previously declined coverage. This right extends to you and all eligible family members if you notify the Benefits Department within 31 days of the event or unless otherwise noted below:

You will be eligible to enroll yourself and eligible dependents in a health care plan if:

• You or your dependents have lost coverage under another plan because:
  • Employer contributions to the plan stopped,
  • The plan was terminated or was amended to exclude all members of a specific class,
  • Coverage ended due to divorce or termination of a domestic partner relationship, legal separation, death, termination of employment, or a reduction in hours to part-time status,
  • You or your dependent incurred claim expenses that exceeded your plan's lifetime maximum, or
  • Your dependent child has reached the plan's maximum age limit.
• A court has ordered you to provide coverage for a dependent.
• COBRA coverage under another plan ends involuntarily.
• Individuals who lose Medicaid or CHIP coverage due to ineligibility
• Gain eligibility for a state's employer-plan premium assistance program
• Termination of your or your Dependent's Medicaid or Children's Health Insurance Program (CHIP) coverage as a result of loss of eligibility (you must contact the Benefits Department within 60 days of termination).
• You or your Dependent become eligible for a premium assistance subsidy under Medicaid or CHIP (you must contact the Benefits Department within 60 days of determination of subsidy eligibility)

In addition, if you gain a new dependent during the year, you may enroll that dependent, as well as yourself and any other eligible dependents, for health care coverage—even if you previously declined health care coverage.