Waiver of medical coverage
Recently, SEGIP issued a new policy allowing some employees
to waive medical coverage. This new policy allows employees eligible for the
full employer contribution under law but NOT under the applicable labor
agreement or compensation plan to waive coverage.
Remember that:
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Agencies are responsible for informing employees
when they are eligible to waive and to provide them the waiver form
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Employees eligible only under law have the
option to elect medical coverage or waive medical coverage—meaning it’s their
decision
Employees eligible for the full employer contribution under
the applicable labor agreement or compensation plan may NOT waive coverage.
Waiver forms, procedures, and information on SEMA4 coding
are available on the SEGIP insurance eligibility webpage.
Waive coverage when moving from full-time to part-time
An employee who was expected to average at least 30 hours of
service per week may revoke (drop/waive) medical coverage if the employee’s
status changes so that the employee is expected to average less than 30 hours
of service. This is true:
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Even if the reduction in hours does not result
in loss of eligibility for medical coverage; and
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For all types of Reg/Temp code
appointments, including Unlimited.
This reduction in hours is a new qualifying life event.
Whenever an employee experiences a qualifying life event the employee may
change coverage to the extent it corresponds to the life event. With this reduction
in hours the employee may waive medical coverage but no other changes to their
benefit elections may be made.
The new qualifying life event language is on the SEGIP understand your benefits webpage. Click on
Summary of Benefits (the life event language is on page 20)
Waiver and Special Eligibility Codes
We have added the Special
Eligibility Code DWF. It indicates that a Seasonal basis employee may waive
coverage.
It is important to use the “D” series Special Eligibility
Codes to identify a Seasonal Basis employee. If the “D” series codes are not
used then the employee will be listed as a NOT Seasonal Basis employee on our
reports. When this occurs an agency may receive a penalty because a Seasonal
Basis employee is eligible for coverage under different circumstances than a
Not Seasonal Basis employee.
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We recommend that agencies with Seasonal Basis employees
review all employees with the Special Eligibility Code “AW12 or AW9.” If any of
those employees are Seasonal Basis employees be sure to change their code to
“DWF.”
We are in the process of updating the Special Eligibility
Code Chart in our resources and reference documents. Once revised, we will
repost these documents and let you know they are completed. In the interim,
check the website for updated information.
PRO agreements and insurance eligibility
It may be
necessary to review all PRO (Post Retirement Option) agreements that were in
place prior to January 1, 2015, to ensure the insurance provision is correct.
An employee may NOT receive both an employer contribution towards insurance
coverage and an employer contribution to the Heath Care Saving Plan (HCSP)
administered by MSRS. We are in the process of updating the PRO policy to
reflect the ESR and the new waiver policy. We will let you know when the new
version is completed.
Contacts
For questions about SEMA4
coding, please contact your SEMA4 HR Specialist. For questions about an
employee’s eligibility, please contact your Agency Services Account Representative. You can find their contact information on the SEGIP insurance eligibility webpage.
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