Enrollment and Eligibility

Open Enrollment

Each year in the fall you have the opportunity to enroll and/or change your Medical, Dental, and/or Vision Plan, without a Qualifying Change in Status event.  Your Employer’s Benefits Administration/Human Resources will provide Open Enrollment instruction to enroll online at shp.benelogic.com.  Your new coverage will be effective January 1 of the following year.

Initial Enrollment (New Employee or Newly Eligible Employee)

You are eligible to enroll in the Plan if you work for a participating employer and you are a member of a group of employees designated by your participating employer as eligible to participate.  To enroll in the Plan for the first time, you must complete the online enrollment process within 31 calendar days after your hire date by logging into shp.benelogic.com.  If you do not enroll within the time frame, you must wait until the next Open Enrollment period or until you experience a Qualifying Change in Status event.  Participating is optional, however, you must complete a waiver online to decline the insurance.

Proof of Eligibility Requirements

Enrollment Instructions and Required Documentation for Eligibility
Spousal Employer Verification Form
Impaired (Disabled) Dependent – Certificate of Impairment Form  – For impaired dependent over age 26
Attending Physician’s Statement of Impairment

Dependent Enrollment and Eligibility

A Spouse and dependent children (up to the age of 26) who meet the Plan’s eligibility criteria are able to enroll in the Scioto Health Plan (SHP) for medical, dental, or vision coverage.

A Spouse that is eligible for enrollment may enroll in SHP for secondary coverage when they are primary on another plan.  However, for a Spouse to enroll in this Plan for primary medical coverage, the Spouse must meet one of the criteria in the attached list:  Eligibility Requirements for a Spouse to Enroll in Medical Plan.

As part of the enrollment process, you will be required to answer the spousal eligibility questions located in the Benelogic system.  If your Spouse is eligible to be secondary, their primary insurance information will need to be entered in the Coordination of Benefits (COB) section of the enrollment process.

If your Spouse is employed but does not have access to an employer-sponsored medical plan, you will be required to have your Spouse’s employer complete the Spousal Employer Verification Form.   Print and complete the form from this link or the Resources Tab in the enrollment portal and upload to your Benelogic file cabinet.

Mid-Year Changes

Your enrollment elections will remain in place for the entire calendar year enrolled.  You may only make changes to your Plan throughout the year if you have a Qualifying Change in Status event.  Changes should be submitted via a Change Request in your Benelogic Employee Portal at shp.benelogic.com.  A Qualifying Change in Status must be submitted within 31 days from the event (and within 60 days to enroll a newly eligible dependent child).  If you go beyond the time limit, you may have to wait until the next Open Enrollment period.  Failure to notify your employer may cause your medical claim payments to be delayed or denied.  Also, your rights to enroll in the Plan or continue coverage may expire.

Proof of a Qualifying Change in Status event is required and must be uploaded to your Benelogic File Cabinet before a Change Request will be approved in the system.

Examples include one or more of the following:

• Marital Status (e.g., marriage, divorce, legal separation, death of a spouse, etc.)
• Number of Children who are Dependents (e.g., birth, death, adoption, etc.)
• Employment Status
• Residence
• Loss of Coverage (e.g., not dropping coverage voluntarily)
• Court Order (e.g., a duly executed judgment, decree, or order, including a QMCSO)

Dropping Coverage Rules

Your health plan allows you to have your premiums deducted pre-tax.  Because of this, the Plan is subject to IRS cafeteria plan regulations.  Under these regulations, employees cannot drop coverage at any time unless it is during the Open Enrollment period of the Plan, or within 31 days of a Qualified Change in Status event.

Note

Please refer to your Plan Benefit Book for complete eligibility requirements for coverage for you and your dependents.  If there is any discrepancy between this information and any official Plan documents, the official Plan document will control.

Support

If you need assistance to enroll or upload required documentation, contact the Administrative Support Team at AST@planmanagementservice.com.