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One month, 31 days max from your date of hire into a benefits-eligible position.
During this time you can enroll in any of the group benefit plans, no health screenings.
Mark the one month date on your calendar so you don’t miss the deadline.
Is there a waiting period for coverage to take effect?
Based on the date you sign up (within 31 day window), your coverage will start on the first day of the NEXT calendar month.
If you turn in insurance forms today, your coverage will take effect on _____________.
Examples of Effective Dates Example 4 Hired March 1 Enroll March 1 or earlier Coverage begins March 1 Example 3 Hired March 1 Enroll March 2 Coverage begins April 1 Example 2 Hired March 6 Enroll April 3 Coverage begins May 1 Example 1 Hired March 3 Enroll March 6 Coverage begins April 1
You can cover these persons on your Medical and Dental plans:
Your lawful spouse
Your unmarried child through age 18, or through age 24 if a full-time student. Includes:
Adopted or foster child (court documentation required)
Your step-child if they live with you in a parent-child relationship at least half of the year. (Even if your spouse is court-ordered to cover a child, you cannot cover the child unless they live with you.)
Grandchildren, nieces and nephews are NOT eligible for coverage unless you have full custody and have legally adopted them (court documentation is always required) , and a parent of the child does not live with you.
Be sure to visit Human Resources within 31 days regarding the eligibility status of a dependent (i.e., marriage, new baby, divorce).
Copay : the flat dollar rate you pay per office visit, hospital stay or prescription.
Deductible : the annual fixed dollar amount you pay before insurance pays. Excludes copays.
Coinsurance : the % of the bill you pay after you’ve satisfied your deductible and/or copay (you pay a %, insurance covers a %)
Out-of-Pocket Max : annual maximum coinsurance you would pay per calendar year (excludes copay and deductible); then insurance pays 100%.
Network provider : Physician or other health care specialist who is listed in the UA QualChoice directory. Little Rock hospitals in the network are UAMS, ACH and St. Vincent's/Doctors, not Baptist or Heart Hospital.
In-network benefits that are the same for Classic and POS
You pay $20 copay to see your PCP or Ob/Gyn doc. Covers services performed in physician’s office.
$35 copay to see other network physician
You pay $500 deductible ($1,000 family) and 20% coinsurance on other services outside doctor’s office
$200 copay per inpatient admission + deductible + $1,000 maximum out of pocket individual ($2,000 family)
Preventive care covered
Routine vision exam covered once every 12 months. You pay $20 copay to see any optometrist or in-network ophthalmologist.
You first pay $1,000 ($2,000 family) as deductible.
Then insurance covers 60% based on Maximum Allowable Charges. Your out-of-network doctor may “balance bill” you the amount over QualChoice’s fee schedule. Your actual cost may be 40% + difference between actual and allowable expenses. Your coinsurance out-of-pocket max is $5,000 ($10,000 family).
PharmaCare will send you a prescription benefit card. Present this to your pharmacist when filling a prescription.
If you need to fill a prescription before you get your card, ask your pharmacist if they can wait and file the claim later, once you’re in PharmaCare’s computer. Or you might have to pay the full cost of the drug from your pocket then file the claim to a paper claim to be reimbursed.
Visit www.pharmacare.com for a list of participating pharmacies. Also find out what your cost will be for your prescription ahead of time.
Delta Dental will send you a “welcome letter” but not a card. You actually don’t need a card. But you may use the one in your packet to write in your name and use as a handy reference for Delta’s phone number.
This card is not proof of insurance. Your dentist will verify your coverage and file a claim electronically through Delta’s website.
Once your coverage begins, register as a Subscriber at www.deltadental.com to view benefits and claim status.
Your risk : You can’t make a mid-year change to your coverage, such as dropping coverage on yourself or family members. You would have to wait until the end of the calendar year, or be within 31 days of a qualified change of status event .
Consider enrolling on an after-tax basis if you think you might drop coverage before end of the year.
You may change your Premium Conversion election at the end of each year (by mid-December), to take effect January 1.
Qualifying Changes in Status include… (as defined by IRS; complete list in HR)
Gain or loss of dependent
Marriage, divorce, legal separation or annulment
Death of spouse or dependent
Birth or adoption
Spouse loses coverage due to loss or change of employment
Your benefit change must be “on account of and consistent with” the qualifying change in status.