| (a) Enrollment Categories.
(1) Full-time employees and their dependents.
(A) A new employee:
(i) who is not subject to the health insurance waiting
period and is eligible under the Act and as provided for in §81.5(a)(1)
of this chapter (relating to Eligibility) for automatic insurance
coverage, shall be enrolled in the basic plan unless the employee
completes an enrollment form to elect other coverage or to waive GBP
health coverage as provided in §81.8 of this chapter (relating
to Waiver of Health Coverage). Coverage of an employee under the basic
plan, and other coverage selected as provided in this paragraph, becomes
effective on the date on which the employee begins active duty.
(ii) who is subject to the health insurance waiting
period and is eligible under the Act and as provided for in §81.5(a)(1)
of this chapter for automatic insurance coverage, shall be enrolled
in the basic plan beginning on the first day of the calendar month
following 60 days of employment unless, before this date, the employee
completes an enrollment form to elect other coverage or to waive GBP
health coverage as provided in §81.8 of this chapter.
(iii) who has existing, current, and continuous GBP
health coverage as of the date the employee begins active duty is
not subject to the health insurance waiting period and is eligible
to enroll as a new employee in health insurance and additional coverage
and plans which include optional coverage by completing an enrollment
form before the first day of the calendar month after the date the
employee begins active duty. Health and additional coverage selected
before the first day of the calendar month after the date the employee
begins active duty are effective the first day of the following month.
(B) Dependent enrollment and optional coverage:
(i) To enroll eligible dependents, to elect to enroll
in an approved HMO, and to elect additional coverage and plans which
include optional coverage, an employee not subject to the health insurance
waiting period shall complete an enrollment form within 30 days after
the date on which the employee begins active duty. Coverage selected
within 30 days after the date on which the employee begins active
duty becomes effective on the first day of the month following the
date on which the enrollment form is completed. An enrollment form
completed after the initial period for enrollment as provided in this
paragraph is subject to the provisions of subsection (d) of this section.
(ii) To enroll eligible dependents or to elect to enroll
in an approved HMO, an employee subject to the health insurance waiting
period shall complete an enrollment form before the first day of the
month following 60 days of employment. Coverage selected before the
first day of the month following 60 days of employment becomes effective
on the first day of the month following 60 days of employment. An
employee completing an enrollment form after the initial period for
enrollment as provided in this paragraph is subject to the provisions
of subsection (d) of this section. The provisions of subparagraph
(A)(ii) of this paragraph apply to the election of additional coverage
and plans, which include optional coverage, for an employee subject
to the health insurance waiting period.
(C) Except as otherwise provided in this section, an
employee may not change coverage.
(D) An eligible employee who enrolls in the GBP is
eligible to participate in premium conversion and shall be automatically
enrolled in the premium conversion plan. The employee shall be automatically
enrolled in the plan for subsequent plan years as long as the employee
remains on active duty.
(E) Coverage for a newly eligible dependent, other
than a dependent referred to in subparagraph (F) or (H) of this paragraph,
will be effective on the first day of the month following the date
the person becomes a dependent if an enrollment form is completed
on or within 30 days after the date the person first becomes a dependent.
If the enrollment form is completed and signed after the initial period
for enrollment as provided in this paragraph, the enrollment form
will be governed by the rules in subsection (d) of this section.
(F) A member's newborn natural child will be covered
immediately and automatically for 30 days from the date of birth in
the health plan in effect for the employee/retiree. A member's newly
adopted child will be covered immediately and automatically from the
date of placement for adoption for 30 days in the health plan in effect
for the employee/retiree. To continue coverage for more than 30 days
after the date of birth or placement for adoption, an enrollment form
for GBP health coverage must be submitted by the member within 30
days after the date of birth or placement for adoption.
(G) The effective date of a newborn natural child's
life and AD&D coverage will be the date of birth, if the child
is born alive, as certified by an attending physician or a certified
nurse-midwife. The effective date of a newly adopted child's life
and AD&D coverage will be the date of placement for adoption.
The effective date of all other eligible dependents' life and AD&D
coverage will be as stated in subparagraph (E) of this paragraph.
(H) GBP health coverage of a member's eligible child
for whom a covered employee/retiree is court-ordered to provide medical
support becomes effective on the date on which the member's benefits
coordinator receives a valid copy of the qualified medical child support
order.
(I) The effective date of GBP health coverage for an
employee's/retiree's dependent, other than a newborn natural child
or newly adopted child, will be as stated in subparagraph (E) of this
paragraph.
(J) For purposes of this section, an enrollment form
is completed when all information necessary to effect an enrollment
has been transmitted to ERS in the form and manner prescribed by ERS.
(2) Part-time employees. A part-time employee or other
employee who is not automatically covered must complete an application/enrollment
form provided by ERS authorizing necessary deductions for insurance
required contributions for elected coverage. All other rules for enrollment
stated in paragraph (1) of this subsection, other than the rule as
to automatic coverage, apply to such employee:
(A) If the employee is not subject to a health insurance
waiting period, this form must be submitted to ERS either through
ERS Online or through his/her benefits coordinator on, or within 30
days after, the date on which the employee begins active duty.
(B) If the employee is subject to a health insurance
waiting period, this form must be submitted to ERS either through
ERS Online or through his/her benefits coordinator before the first
day of the month following 60 days of employment.
(C) If the employee has existing, current, and continuous
GBP health coverage as of the date the employee begins active duty,
the employee is not subject to the health insurance waiting period
and is eligible to enroll as a new employee in health insurance and
additional coverage and plans which include optional coverage by completing
an enrollment form before the first day of the calendar month after
the date the employee begins active duty. Health and additional coverage
selected before the first day of the calendar month after the date
the employee begins active duty are effective the first day of the
following month.
(3) Retirees and their dependents.
(A) Provided the insurance required contributions are
paid or deducted, an employee's GBP health, dental, vision and term
life insurance coverage (including eligible dependent coverage) may
be continued upon retirement as provided in §81.5(b) of this
chapter. The life insurance will be reduced to the maximum amount
which the retiree is permitted to retain under the insurance plan
as a retiree. All other coverage in force for an active employee,
but not available to a retiree, will automatically be discontinued
concurrently with the commencement of retirement status. Except as
provided in subparagraph (E) of this paragraph, if a retiree retires
directly from active duty and is not covered as an active employee
on the day before becoming an annuitant, the retiree may enroll in
the basic plan.
(B) A retiree may enroll in GBP health, dental, vision
and life insurance coverage for which the retiree is eligible as provided
in §81.5(b) of this chapter, including dependent coverage, by
completing an enrollment form as specified in clauses (i) - (iii)
of this subparagraph. For the purposes of this subparagraph, the effective
date of retirement of a retiree who is eligible to receive, but who
has not yet received, an annuity is the date on which ERS receives
written notice of the retirement. An application/enrollment form received
after the initial period for enrollment as provided in this subparagraph,
is subject to the provisions of subsection (d) of this section.
Cont'd... |
