Group Medical Insurance Eligibility

Eligible Employees:

You are eligible to enroll in a County Medical, Prescription Drug, Vision and or Dental Plan if:

• You are a regular full time or regular part time employee who works a minimum of 30 hours every week.

Eligible Dependents:

Eligible employees who enroll in a County Medical / Prescription or Dental Plan may also enroll eligible dependents in the Plan.  Eligible dependents include:

• Spouse / Civil Partner (Copy of marriage / Civil Union certificate required)
• Natural children, stepchildren, foster children, adopted children, children of whom an employee or spouse/civil partner is appointed legal guardian. (A copy of the birth certificate or other legal document showing both the child and parent’s name is required. For legal guardian, a copy of the court order is required) 

Dependent Eligibility for County Medical Plan
Children who are dependent chiefly on the subscriber or enrolled spouse / civil partner for support and maintenance are covered until the end of the month they turn 26 years of age.

• Verification of Dependent Eligibility must be submitted by completing the Affidavit of Dependency form.

Dependent Eligibility for Prescription Plan
Children who are dependent chiefly on the subscriber or enrolled spouse / civil partner for support and maintenance covered until the end of the month they turn 26 years of age.

• Verification of Dependent Eligibility must be submitted by completing the Affidavit of Dependency form.

Dependent Eligibility for Dental Plan
Children who are dependent chiefly on the subscriber or enrolled spouse / civil partner for support and maintenance are covered until the age of 19.
Children who are full time students will be covered until the end of the month they turn 23 years of age or until they term their student status.

• Copy of a letter from a college noting full time student status is required.

Enrollment Requirements

New Hires:
Eligible employees who elect coverage under the County’s medical and prescription plan must enroll by completing the applicable enrollment application forms and submitting them to the Human Resources Benefits Division within the first week of their employment.

Coverage starts:

• Immediately following the completion of the month in which you started, plus, two full calendar months of employment. 
• If you commence employment on the first work day of a month, that month is included in computing the two full months.

Open Enrollment
Each year the County holds an open enrollment period during which employees may change medical, dental coverage, and/or vision, enroll and add dependents.

To change plans your enrollment materials must be received by the Human Resources Benefits Division within the guidelines as per the related open enrollment memorandum (date to be announced each year).  See Insurance Timelines.

If you are adding or deleting dependents, obtain the appropriate change form, available on line, and submit to Human Resources Benefits Division within the enrollment period. See Insurance Timelines.

When Coverage Begins: 
If enrollment takes place during the County’s annual open enrollment period, coverage begins as defined by the individual plan.  See Insurance Timelines.

When Coverage Ends:
Coverage under the County’s medical, prescription drug and dental plans will end on the earliest of the following dates:

Medical Plans

• For eligible employees and their eligible dependents only, when the employee’s separation or the date the employee otherwise ceases to meet the requirements of an eligible employee
  • If you separate after the first work day of the month, you will be covered for that month and through the end of the following month.
  • If you separate on the first work day of the month, you will be covered through the end of that month.
• For dependents only, same as above. 

Prescription Drug Plan

• For eligible employees and their eligible dependents only, when the employee’s separation or the date the employee otherwise ceases to meet the requirements of an eligible employee
  • If you separate after the first work day of the month, you will be covered for that month and through the end of the following month.
  • If you separate on the first work day of the month, you will be covered through the end of that month.
• For eligible dependents, same as above or until the end of the month they turn 26 years of age.

Dental Plans-

         Horizon

• For eligible employees, when separating from County service on or before the first payday of the month, coverage ends the last day of the same month. When separating from County service on or after the second payday of the month, coverage will end on last day of the next month following separation from service. 
• For eligible dependents, coverage ends at age 19 unless a full time student, upon proof of student status coverage ends at the end of the month that they turn 23 years of age.

• For eligible employees, when separating from County service on or before the first payday of the month, coverage ends the last day of the same month. When separating from County service on or after the second payday of the month, coverage will end on last day of the next month following separation from service. 

• For eligible dependents, coverage ends at the end of the month that they turn 26 years of age.

• Leave of Absence:  Eligible employees may continue coverage during a leave of absence or suspension without pay provided they continue bi-weekly contributions (if applicable).
  Whether or not an eligible employee elects to continue coverage, coverage will be reinstated on the first day of return to active employment with the County.

C.O.B.R.A. Continuation Coverage

Federal law allows you and your eligible dependents to continue medical, prescription drug and dental coverage at your own expense under certain circumstances when health coverage would otherwise end. C.O.B.R.A. coverage is available if coverage would be lost under any of the following qualifying events:

• Termination of employment
• Retirement
• Employee death
• Employee’s or retiree divorce or legal separation
• A dependent ceasing to qualify as an eligible dependent

Notification Requirements
In the event of divorce, legal separation or a dependent ceasing to qualify as an eligible dependent, you or a family member must notify the County’s Human Resources Benefits Division within 30 days after that event occurs. If notice is not received by the end of the 60th day, the affected spouse or dependent will not be eligible for C.O.B.R.A. continuation coverage.

C.O.B.R.A. (Consolidated Omnibus Budget Reconciliation Act) 
C.O.B.R.A. provides certain former employees, retirees, spouses, former spouses and dependent children the right to temporary continuation of health coverage at group rates. The plan administrator will send you an information package within 14 days of a qualifying event.

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