Health Plan Self-Pay FAQs

  1. What are the Self-Pay rates?

    Please see the chart below for Self-Pay coverage options effective January 1, 2016.

    Options Plan I Plan II
    (with 3 or more Health Years)
    Plan II
    (with less than 3 Health Years)

    Benefits

    Hospital, Medical, Prescriptions, Dental, Vision, Mental Health/Substance Abuse Hospital, Medical, Prescriptions*, Dental Hospital, Medical, Prescriptions*

    Individual only

    $624/monthly $539/monthly $508/monthly

    Individual plus
    1 dependent

    $1,225/monthly $1,058/monthly $999/monthly

    Individual plus
    2 or more dependents

    $1,705/monthly $1,472/monthly $1,391/monthly

    *Does not include prescription drugs for mental health and substance abuse treatment.

  2. When is my Self-Pay enrollment form due?

    Your completed enrollment form is due within 60 days of the later of: the date coverage terminated or the date on your Self-Pay enrollment offer.

  3. How long will it take to process my enrollment form?

    Please allow up to 2 business days to process your enrollment form. You will receive a confirmation letter in the mail once your enrollment has been processed. For faster service, log into our secure website to make changes to your dependents and make your premium payment.
  4. When is my self-pay premium due?

    Premiums are due the first of the month. However, we accept payments with a postmark through the last day of the month. Remember, self-pay coverage will only be extended when your enrollment is completed and payment is received in full.
  5. Where can I see an overview of my payment options?

    Click here for a chart showing each of the methods for making self-pay payments.

  6. Can I stop by the office and pay my premium in cash?

    No. We do not accept cash payments.

  7. What if I cannot afford to make my monthly payments?

    We maintain a list of Assistance Organizations that may be of help to you!

  8. How can I change my tier rate?

    Your tier rate is based on the number of dependents covered under the Plan. During the Annual Open Enrollment Period, you can enroll/dis-enroll your dependents by submitting your Open Enrollment Form or completing the process on our website.
  9. When will I receive my annual payment coupons?

    You will receive your annual payment coupons after your enrollment has been processed.
  10. If I am enrolled in Auto-Debit and change my tier during Open Enrollment, will the deduction amount automatically change?

    Yes. Once your enrollment is processed, the deduction amount will automatically change to your new tier rate. The new rate will be deducted around the 25th of the month prior to the next premium due date, provided that your account is paid current.
  11. What are enrolled and dis-enrolled dependents?

    Enrolled dependent(s) are qualified family members you have chosen to cover. Once your premium payment is received, you and your enrolled dependent(s) will have health coverage. Dis-enrolled dependent(s) are individuals you have chosen not to cover. Dis-enrolled dependents are not eligible for health coverage or Self-Pay. Dependents may only be enrolled or dis-enrolled during the Annual Open Enrollment Period or if a life event occurs.
  12. Can I change my coverage when I add or drop dependents? For example, if I am single when I start self-pay but then get married, can I add my new spouse?

    Yes, provided you notify the Plan Office within 60 days from the date of the event (e.g., birth, marriage, divorce, death, adoption, etc.). You must provide documentation of the event and submit a completed New Dependent Form.

  13. What is Open Enrollment?

    The period of time each year where you will have the opportunity to make changes to your dependent/tier enrollment. Please note that you will not be able to change your original plan type selection. Open Enrollment materials will be mailed each November. Enrollment changes must be completed online or by submitting a paper form by the deadline to be effective January 1st of the following year.

  14. During Open Enrollment, how can I add a dependent that is not currently listed on file?

    To add a dependent during Open Enrollment, you must submit a New Dependent Form and all required documents to consider your dependent(s) as qualified. Examples are a recorded marriage certificate for a spouse or a recorded birth certificate for your dependent child. Please indicate on the form if you would like the dependent(s) enrolled in the Health Plan and submit your documents via fax, email or mail. If adding the dependent(s) changes your tier rate, we will send you updated payment coupons that reflect your new premium amount. Please see the Self-Pay Program Summary for more information.

  15. If I want to dis-enroll my dependent(s) during Open Enrollment, what do I need to do?

    Simply use our secure website to make the change. No other paperwork or explanations are required. You also have the option of making your selections on your Open Enrollment Form by checking the appropriate boxes and returning the form to the Plan Office.

  16. Can I dis-enroll myself as a participant but elect coverage for a dependent?

    In some cases, your dependents may be entitled to enroll in the program even if you do not elect coverage. Contact the Plan Office for more information.

  17. Can I enroll or dis-enroll my dependent(s) outside of my Open Enrollment Period?

    You may make dependent enrollment changes outside of the Open Enrollment Period if you experience a life event that results in a change in family status. A change in family status is defined as an increase or decrease in the number of your dependents, which may result from birth, adoption, marriage, establishment of a same-sex domestic partnership, divorce, dissolution of a qualified same-sex domestic partnership, death or loss of dependent "child" status as defined by the Plan, or if your dependent obtains or loses insurance coverage on their own.

    If one of these events should occur, you will be permitted to change your dependent's enrollment status and change your premium tier (if applicable) based on the addition or loss of that dependent. A written request must be submitted to the Plan Office within 60 days from the date on which the life event occurred. No verbal requests will be accepted.

  18. I dis-enrolled my dependents while on Self-Pay coverage. If I qualify for Earned coverage, will my Self-Pay dependent enrollment selections carry over?

    If you qualify for Earned coverage, you will have the opportunity to make changes to your enrolled dependents during your Earned Open Enrollment Period.
  19. If I dis-enroll my dependents while on Self-Pay coverage, what will I happen if I qualify for the Senior Performer plan?

    Qualified dependents will automatically be re-enrolled if and when you qualify for the Senior Performer plan. You will have the opportunity to make changes to your enrolled dependents during your Senior Performer Open Enrollment Period.

  20. Can I elect which month I want to enroll in self-pay?

    No. Self-Pay coverage must be continuous from the first day following the last day of Earned coverage.
  21. May I enroll for dental coverage only on self-pay?

  22. I'm getting divorced. Is my former spouse entitled to Self-Pay coverage of their own?

    You must notify the Plan Office of your divorce within 60 days from the date of divorce. Your former spouse would be entitled to a maximum of 36 months of Self-Pay coverage from the date Earned Eligibility was lost.

  23. I previously dis-enrolled my spouse from coverage and am now getting a divorce. Is my former spouse entitled to self-pay coverage of their own?

    Possibly. Please contact the Plan Office for more information.

  24. When will my Notice of Eligibility packet be sent?

    Notice of Eligibility (NOE) packets will be mailed once your enrollment is completed and your initial premium payment is received.

  25. Can I print out my NOE online once my payment is made?

    Yes, after your enrollment has been processed and your initial payment has been posted. Please allow up to 48 hours for your payment to post to your account before attempting to print your NOE.

  26. What am I eligible for after I have used up all of my self-pay coverage?

    You will be offered a conversion policy or you may look for private insurance. If you are totally disabled, you may qualify for an extension of coverage. Please contact the Plan Office for more information.