New and Returning Health Plan Participants

If you are qualifying for Health Plan coverage for the first time or returning to the Health Plan after a break in coverage, follow these steps to ensure a smooth Open Enrollment process.

Step 1: Submit Your Payment (if applicable)

• The applicable dependent premium is due if you have qualified for earned coverage (met the minimum earnings requirement) and are covering one or more dependents.
• The applicable self-pay premium is due if you are covered under either COBRA or any of the Health Plan’s self-pay or retiree coverages.

You can make your payment by credit card, debit card or bank account via Online Bill Pay or Pay-by-Phone, or you may pay by check or automatic pension deduction.

Step 2: Forms to Complete

Complete the following forms:

• Coordination of Benefits Form: You must notify the Health Plan whether you or your dependents have other group health insurance. All participants must complete and return this form annually or every benefit period, even if you do not have other insurance.
• Dental Election Form: If you are a California participant and want to elect the Dental HMO option, complete and return this form to the Health Plan office.If you live outside California, you are automatically enrolled in the Delta Dental PPO Plan and do not need to submit this form.
• Dependent Enrollment Form: If you are adding dependents to your coverage, complete and return this form. When you return the form, be sure to also include the required dependent enrollment documentation for each of your dependents. The required documentation is detailed on the form.
• Joint Documentation: If you have been married for more than one year, you will also need to submit one of the following documents (no older than six months):
  • A copy of the front page of your most recent filed federal tax return; or
  • A copy of a joint household bill, such as gas, water, or electric; or
  • A copy of a joint bank/credit account statement; or
  • A copy of your joint mortgage/lease; or
  • A copy of your joint insurance policy.

  The financial information on the forms above can be redacted.

Step 3: Learn about Your Benefits

Refer to the March 2020 Health Plan Summary Plan Description for detailed benefit descriptions and requirements.

Step 4: Return Your Completed Forms

Return your completed forms, documentation and payment (if applicable) to the Health Plan office prior to the end of your Open Enrollment Period.