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)
(with less than 3 Health Years)
|Hospital, Medical, Prescriptions, Dental, Vision, Mental Health/Substance Abuse||Hospital, Medical, Prescriptions*, Dental||Hospital, Medical, Prescriptions*|
*Does not include prescription drugs for mental health and substance abuse treatment.
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.
Click here for a chart showing each of the methods for making self-pay payments.
No. We do not accept cash payments.
We maintain a list of Assistance Organizations that may be of help to you!
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.
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.
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.
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.
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.
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.
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.
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.
Possibly. Please contact the Plan Office for more information.
Notice of Eligibility (NOE) packets will be mailed once your enrollment is completed and your initial premium payment is received.
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.
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.