Spouses may be enrolled for medical, dental, and vision coverage within 60 days from the date of marriage. If not enrolled during this time period, spouses must wait until the next enrollment period to be eligible for coverage in the next contract year. A copy of the Marriage License is required at the time of enrollment of a new spouse.

If you do not add your new spouse within 60 days of your date of marriage, your spouse will not have coverage and will not be eligible for coverage until the next open enrollment period.

You may add your spouse to insurance by logging on to www.pehp.org within 60 days of your marriage.

Coordination of Benefits and Dual Coverage

PEHP plans will coordinate benefits with other individual, group, or HMO health insurance contracts. The employee must inform PEHP of other medical coverage in force by completing a Duplicate Coverage Form (found on the Enrollment Form and Change Form). It is the responsibility of the employee to provide complete and accurate information regarding other coverage and to be sure benefits are coordinated in the proper order. The employee shall submit to PEHP written notice of changes, additions, or termination of other coverage. Documentation should include:

• the other insurance company’s name and phone number

• the subscriber or policyholder of the other plan and the plan ID number

• dependents covered by the other plan

• the type of coverage (medical and/or dental)

• the effective and/or termination dates of coverage

When a spouse enrolls on a second PEHP plan creating dual coverage (a combination of two or more PEHP plans), that plan is subject to the usual pre-existing condition clause.

It is very important to review your spouse’s health care to ensure that Coordination of Benefits is offered. There are some programs that do not allow for other or dual coverage.

If you and your spouse each have coverage, PEHP will coordinate with the other coverage. You are primary on your coverage, your spouse is secondary on your coverage, and the children will follow the birthday rule (the parent whose birthday is first during the year will have primary coverage for the children). It is very important that you review your spouse’s coverage. There are some plans that do not allow for coordination of benefits.

To notify PEHP of the Coordination of Benefits or Dual Coverage, please log on to www.pehp.org and fill out section C – Multiple Group Coverage of the Medical and Dental Enrollment and Change Form.

Certification and Disclosure of Coverage

At the time of enrollment, the employee must provide PEHP with a Certification and Disclosure of Coverage or other acceptable documentation of creditable coverage. If no certification or other documentation of creditable coverage is provided, the Pre-existing Condition Exclusion Period will automatically be applied.

This certification is provided to you when you leave employment if you had medical coverage. The certification will allow the pre-existing period to be waived. If you have a pre-existing condition (for example, diabetes or high blood pressure), you can continue to see your doctor without the consequence of limitation for your health condition. If you don’t have the certification, you risk a limit of coverage for any previously diagnosed health conditions.

Loss of Spouse’s Coverage

If an employee declines PEHP coverage during the enrollment period because of other health coverage (including COBRA) and subsequently loses that coverage because of becoming ineligible for that coverage, or employer payments toward the other coverage have been terminated, PEHP shall allow the employee to enroll within 60 days from the date of the termination of the other coverage. An employee shall not be allowed to enroll with PEHP if the employee chooses to terminate the other coverage.

If your spouse had other coverage, he or she would be eligible for enrollment on your coverage. Also, if the children were on your spouse’s coverage, they are also eligible for enrollment on your coverage. If you do not enroll your spouse and/or children within 60 days of losing coverage, they will not be eligible to enroll until the next open enrollment period.

You may add your spouse to insurance within 60 days of your spouse’s termination date by logging on to www.pehp.org and submitting a Medical and Dental Enrollment and Change Form to PEHP.

An employee can select a coverage amount ranging from $25,000 to $250,000, and the employee’s spouse is automatically insured for 40% of the coverage amount. If the employee has no dependent children, the spouse’s coverage increases to 50% of the coverage amount.

Once enrolled in the AD&D Family Plan, you would be the beneficiary in the event of your spouse’s death. You would receive 40% of the coverage amount that you chose for yourself as the employee. If you do not have children, you would receive 50% of the coverage amount.

You may purchase Accidental Death and Dismemberment insurance for your spouse within 60 days of your date of marriage by logging on to www.pehp.org and submitting the Accidental Death and Dismemberment Plan Enrollment/Change Form.

Beneficiary Designation

A new marriage is the perfect time to review beneficiary designations for URS and life insurance plans.