2005 Active Employee Health Insurance Handbook Member Responsibilities
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Read this Handbook to learn about your benefits |
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It is your responsibility to know what benefits are covered, how they are covered and when they are covered. Direct questions to the Department for Employee Insurance and your health insurance carrier. Read your Certificate of Coverage and any other information you receive from your health insurance carrier. Before you have medical services performed, make sure they have been pre-certified, if applicable. Treatment for non-covered services is ultimately your responsibility. If your health insurance carrier does not pay, you are responsible for payment to the provider. ^Top
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Plan your decisions wisely |
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Determine which option will best suit your needs and the needs of your family. Determine the amounts that will be deducted from your paycheck. After you have made your selections, you will not be allowed to change them unless you experience a Qualifying Event that would allow a change. ^Top
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Complete, sign and submit your application timely |
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Refer to the [Open Enrollment Information] section for the deadline to submit your Open Enrollment health insurance application. You MUST complete an application for 2005. If you fail to complete the health insurance application, you will not have health insurance coverage for 2005. Additionally, if you experience a Qualifying Event during the Plan Year, you must complete the required application or form within the established deadlines [(refer to Qualifying Events section for details)]. ^Top
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Verify that your deductions are correct |
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It is your responsibility to review your first paycheck for your 2005 Plan Year deductions. For state employees, this is the December 15th paycheck for pay period ending November 30. If it is not accurate, contact your agency's health insurance coordinator. If the option you selected on your Open Enrollment application is not what is being deducted from your paycheck, your agency's health insurance coordinator should contact the Department for Employee Insurance for the necessary corrections. However, if the deductions are consistent with your application, no changes will be allowed. ^Top
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Notify your agency's health insurance coordinator of any eligibility changes |
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You must notify your agency's health insurance coordinator if you experience life changing events that may impact eligibility for you or your dependent(s) such as, but not limited to:
- Birth of a child;
- Adoption of a child or placement for adoption;
- Marriage, divorce, legal separation, annulment;
- Death of spouse or dependent;
- Dependent child reaches 24 years of age;
- An employment status change for you, your spouse, or your dependent(s) that affects eligibility under the plan;
- A Court Order that results in the gain or loss of a dependent; or
- Dependent becomes covered by another group health plan.
IF YOU ARE UNSURE HOW A SPECIFIC EVENT MAY AFFECT YOUR HEALTH INSURANCE, IT IS IN YOUR BEST INTEREST TO CONTACT YOUR AGENCY'S HEALTH INSURANCE COORDINATOR IMMEDIATELY FOR ASSISTANCE.
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