New Dependent

Birth or Adoption of a Child

Dependent children may be enrolled for medical, dental, or vision coverage within 60 days from the date of birth or placement in the employee’s home. A copy of the birth certificate is required by PEHP to add a newborn. If not enrolled during this time period, dependents must wait until the next enrollment period to be eligible for coverage in the next contract year.

Employees know how important medical coverage is but often forget to enroll newborns in dental. If dental is waived, the child will not be eligible until the following open enrollment period. For peace of mind and effective coverage, sign up for dental at the time of birth and before the baby’s first dental appointment.

After your baby is delivered, please remember to add the child to your coverage. Do not assume that the baby will automatically be added because PEHP paid the delivery charges. This is not the case. PEHP needs an enrollment form and a copy of the birth certificate. In addition, notify PEHP of the baby’s new Social Security number as soon as possible.

You may add your child to insurance within 60 days of their date of birth by logging on to www.pehp.org and submitting a Medical and Dental Enrollment and Change Form to PEHP.

Adoption of a Child

Adoption benefits for legal or agency fees may be available, subject to plan limitations. To be eligible for adoption benefits, the adoptive parent must have been an employee for three months before the placement of the child. The child must be 90 days from birth at the time of placement. These adoption benefits will not be payable until the adoption becomes final and proper documentation is provided. Exclusions from coverage relating to adoption benefits include:

expenses incurred for the adoption of nieces, nephews, brothers, sisters, grandchildren, cousins, or stepchildren
transportation, travel expenses, accommodations, passport fees, translation fees, photos, postage, etc.
living expenses, food, and/or counseling for the birth mother

When the child is placed in your home, remember to add the child. PEHP must have an enrollment form and a copy of the birth certificate. All necessary documentation must be submitted for reimbursement if you would like to utilize the adoption benefits. In addition, notify PEHP of the child’s Social Security number as soon as possible.

You may add your child to insurance within 60 days of their date of adoption by logging on to www.pehp.org and submitting a Medical and Dental Enrollment and Change Form to PEHP.

Stepchildren

Children or stepchildren of the subscriber who have never been married, up to the age of 26, and who have a Parental Relationship with the subscriber may be enrolled in PEHP’s medical, dental, and vision plans.

If you do not enroll your dependent or stepchild within 60 days of either the date of birth or placement in the home, your child will not have coverage until the next open enrollment period.

You may add your child or stepchild to insurance within 60 days of birth or placement in your home by logging on to www.pehp.org and submitting a Medical and Dental Enrollment and Change Form to PEHP.

Benefits

Term Life

The employee may enroll for Dependent Child Coverage for up to $15,000. An employee who does not apply for coverage for his or her dependents within 60 days from the date of eligibility must furnish, at the employee’s expense, satisfactory evidence of the dependent’s insurability before the dependent can obtain coverage. The Plan has the right, if the Evidence of Insurability is not satisfactory, to decline coverage to the dependent.

You may elect Dependent Child Coverage within 60 days from the date of birth or placement in your home, and you may choose up to $15,000 without providing Evidence of Insurability. In the event of your dependent’s death, you (the employee) would receive the death benefit. Log on to www.pehp.org and submit the Term Life form.

Accidental Death and Dismemberment (AD&D Family Plan)

An employee can select a coverage amount ranging from $25,000 to $250,000, and each dependent child is automatically insured for 15% of the employee’s coverage amount. If an employee has no spouse, each eligible dependent child’s coverage increases to 20% of the employee’s coverage amount.

Once enrolled in the AD&D Family Plan, you will be the beneficiary in the event of your dependent’s death. You would receive 15% of the coverage amount that you chose for yourself as the employee. If you don’t have a spouse, you would receive 20% of the coverage amount. Log on to www.pehp.org and submit the AD&D Form.

Beneficiary Designation

Adding a new dependent is a perfect time to review beneficiary designations.

FLEX$

If an employee adds a new dependent, they can change Flex$ elections for dependent care. See Changing FLEX$ Elections for more details.

When withholding elections regarding dependent care, consider that:

A qualified daycare center, nursery school, babysitter, or nurse can provide care
A maid or cook, if part of their job is to care for a person who qualifies for dependent care, is covered
A relative who provides dependent daycare cannot be your dependent for income tax purposes and cannot be your child or stepchild under age 19
The IRS only allows $5,000 per couple for dependent daycare

If you enjoy the pre-tax benefits of using a FLEX$ spending account, you can change your withholding elections whenever you add a new dependent to your coverage. For new parents, this is especially beneficial if the baby uses day services.

WeeCare

WeeCare is PEHP’s pregnancy case management service. It is a prenatal risk reduction program offering expectant mothers educational, consultative, and pregnancy case management services.

When a member calls WeeCare within the first or second trimester of pregnancy, prenatal vitamins may be authorized at 100% through the pharmacy system. The member will receive an additional incentive of $100 cash if contact with WeeCare is made during the first trimester or an incentive of $50 cash if contact with WeeCare is made during the second trimester. Cash incentives are payable at the end of the pregnancy. While WeeCare is not intended to replace the member’s physician or regular prenatal care, it will provide the member with another resource to answer questions during pregnancy. After initial contact with WeeCare, the member will receive educational materials concerning pregnancy.

You will get paid money after a healthy delivery. Also, you or your spouse can access the WeeCare nurses to ask any questions you might have during the pregnancy. The WeeCare nurses are never to replace your regular physician but are intended to be an enhancement and additional resource during the pregnancy. If you have complications during your pregnancy, the WeeCare nurses will assist you in making arrangements for additional care that might be required. Remember that this benefit is offered free of charge as long as you have PEHP medical coverage.

How to Register for WeeCare and Obtain WeeCare Rewards

As soon as the pregnancy is confirmed, call WeeCare at (801) 538-9943 in the Salt Lake area or toll-free at (800) 662-9660 through the rest of Utah. A registered nurse will call back for a short telephone interview to determine possible risk factors. Following the interview, the expectant mother’s care provider will be informed by mail of her WeeCare participation. The mother-to-be will be contacted by mail throughout the pregnancy. Cash incentives will be provided after the baby's birth if certain criteria are met when registering for WeeCare.

WellCare and Immunizations for Children

PEHP’s WellCare Program consists of coverage for routine care. This benefit is also available for CDC-recommended immunizations. Consult with your child’s pediatrician to determine which immunizations he or she recommends for your child’s needs. Applicable co-payments apply.

Your child can visit his or her pediatrician for wellness visits and immunizations as often as the pediatrician recommends. All you need to do is make your regular office co-payment.

Other

Update Address: Click here to learn more about updating your address.

Update W-4: Employees can update W-4 forms on the Employee Self Service (ESS) System or by submitting a new W-4 form and submitting it to payroll@utah.gov

Obtain Social Security Card for New Dependent: You can apply for a Social Security Card when the baby is born or apply directly at the Social Security Administration.

FMLA: Review the Employee Guide to FMLA and contact HR to learn more about the FMLA options.

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