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Eligibility

  • Employees.
  • Dependents.
  • Divorce.  
  • DHS-directed dependent additions (National Medical Support Notice).
  • Surviving dependents.
  • Transfer employees.
  • Returning to work after leaving employment.

Employees

To be eligible to participate in the plans offered through EGID:

  • An education employee must be eligible to participate in the Oklahoma Teachers’ Retirement System and work a minimum of four hours per day or 20 hours per week. Part-time education employees are those who meet the requirements of a half-time employee as defined by the Oklahoma Teachers’ Retirement System.
  • A local government employee must be in a position requiring a minimum of 1,000 hours or more per year and not listed as a seasonal or temporary employee.
  • Other persons must be elected by popular vote or on approved leave without pay status (not to exceed 24 months).

Coverage for a new employee is effective the first day of the month following their employment date or employer eligibility date. For additional details, refer to EGID administrative rule 260:50-3-15, Effective dates of coverage for current employees.  

An employee may choose not to enroll in an EGID health or dental plan or may disenroll from these plans because of other health or group dental coverage or due to eligibility for military or Indian Health Service benefits within 30 days from the date they become eligible for the other health or group dental coverage. Subsequently, an employee who loses other health or group dental coverage (including military or IHS) may enroll in coverage through EGID within 30 days from the date of loss of the other coverage. 

If you have an employee who chooses not to enroll in an EGID health or dental plan, proof of other health coverage is required. Proof of other health coverage includes:

  • Certificate of health plan coverage.
  • ID card for military health or Indian Health Service benefits.
  • Letter from previous employer that lists dates of coverage and all covered dependents.

Other health coverage cannot be an excepted benefit. Refer to Excepted Benefits in the Glossary section.

Vision coverage is the only benefit that is available without proof of other health coverage.

A new employee is eligible for Guaranteed Issue life coverage at the time of their initial enrollment. Guaranteed Issue refers to the set amount of Supplement Life coverage available to them during initial enrollment without providing a life insurance application. This amount is available to your employee during the first 30 days they are eligible to enroll. This is their only opportunity to have a guaranteed issue amount of life insurance. Guaranteed Issue is equal to two times their current annual salary, with the total rounded up to the next $20,000 unit. 

A new employee has 30 days from their eligibility date to make changes to their initial coverage by completing a new Insurance Enrollment Form. These changes are effective the first day of the month following the date of the change. Changes outside this 30-day window can be made only if a midyear qualifying event occurs or during the annual Option Period. 

Dependents

A new employee can enroll their eligible dependents within their 30-day initial enrollment period. Dependent coverage not elected at this time is not available until the next Option Period or within 30 days of a qualifying event. Refer to Midyear Enrollment Changes in the Enrollment section.

Dependents are eligible only for coverage in which the employee is enrolled.  

For all elected coverage, if one eligible dependent is covered, all eligible dependents must be covered. An employee can exclude eligible dependents with proof of health, group dental or vision coverage. Also, the employee can elect not to cover dependents who do not reside with them, are married, are not financially dependent on them for support, have other coverage or are eligible for military health or IHS benefits. Refer to Excepted Benefits in the Glossary section. 

When an employee’s spouse also works for an EGID-recognized employer and is covered under or eligible for benefits under EGID, the spouse and dependent children cannot have duplicate coverage, except for Dependent Life. Dependent benefits can only be covered under one primary insured except in the case of Dependent Life. 

Dependents are not required to have health coverage to be eligible for dental or life coverage. Only the primary member must have health coverage.

Effective dates of coverage for dependents

Coverage is effective the first day of the month following enrollment. Coverage for enrollment during Option Period is effective Jan. 1. Exceptions include:

  • Newborn – The effective date of coverage is the first day of the month of birth. Refer to Policies for newborn coverage.
  • Adoption or legal guardianship – At the employee’s option, the effective date of coverage is either the first day of the month in which the employee gains physical custody or the first day of the following month.
  • Court order – The court dictates the effective date of coverage.

Spouse

A spouse can be enrolled in coverage as long as a divorce or legal separation has not been filed. Likewise, a spouse cannot be dropped from coverage while in the process of divorce or legal separation. Refer to Divorce. Please note the following:

Common-law spouse – Common-law marriage is recognized by EGID. A new employee can add a common-law spouse at the time of enrollment. A current employee can request coverage on a common-law spouse during the annual Option Period or in the event the common-law spouse loses other coverage. To enroll a common-law spouse, the employee and spouse must sign the Common-Law Spouse Certification on the appropriate form. Once a common-law marriage is publicly declared, it can be dissolved only through a legal divorce.

Excluding a spouse

An employee can exclude their spouse from health and/or dental coverage without proof of other coverage, even if they cover dependent children. To exclude their spouse while covering dependent children, the spouse must sign the Spouse Exclusion Certification on the appropriate form. To exclude a spouse from vision coverage while covering dependent children, the spouse must provide proof of other group vision coverage.

Dependent children

Eligible dependent children include:

  • Daughter, son, stepdaughter, stepson, eligible foster child, adopted child, child for whom the employee has been granted legal guardianship or child legally placed with the employee for adoption, up to age 26, whether married or unmarried.
  • A dependent, regardless of age, who is incapable of self-support due to a disability diagnosed prior to age 26. For additional information, refer to Special rules for a disabled dependent below.
  • Other unmarried children up to age 26 who live with you and for whom you are primarily responsible. This requires completion and approval of an Application for Coverage for Other Dependent Children. A tax return showing dependency can be provided in lieu of the application.

If both parents are primary members under EGID, dependent children can be covered under either parent’s health, dental and vision plan (but not both). However, both parents can cover dependents under Dependent Life.

Special rules for a disabled dependent

A disabled dependent child must be incapable of self-support because of mental or physical incapacity that existed prior to age 26. The dependent is eligible to continue coverage as long as they meet all eligibility rules. To apply to continue coverage for a disabled dependent beyond age 25, the primary member must:

  • Submit a copy of their most recent federal or state tax returns to provide proof of dependent status.
  • Complete a Disabled Dependent Assessment form and return it to EGID according to the time frames below:
    • New employees must submit the form within 30 days of enrollment.
    • Current employees must submit the form at least 30 days prior to the dependent’s 26th birthday.
    • Former employees who added or continued coverage on a disabled dependent at retirement must submit the form at least 30 days prior to the dependent’s 26th birthday.

NOTE: The Disabled Dependent Assessment form must be approved by EGID before coverage begins or is continued. If the form is not received within the designated time frame, coverage or continuation of coverage is denied.

Policies for newborn coverage

For all health plans, employees have 30 days from the date of birth to enroll a newborn for coverage. The newborn must be enrolled effective the first of the month of the child’s birth.

 Adding a newborn to coverage:

  • A newborn must be added the first of the month of the child’s birth. The employee has 30 days from the date of birth to enroll a newborn. An Insurance Change Form must be completed and submitted to you or EGID.
  • Premiums for the full month of the child’s birth must be paid.
  • Unless there is proof of other coverage, when one or more eligible dependents are currently covered, a newborn must be enrolled in the same coverage. Current employees must provide you with proof of the other coverage.
  • When enrolling a newborn in coverage, all other eligible dependents must be enrolled (if they are not already enrolled). A member can exclude a spouse from health and/or dental coverage.
  • A member can request coverage for a newborn grandchild by completing an Application for Coverage for Other Dependent Children. Coverage for a grandchild is effective the first of the month following the receipt and approval of the application and payment of premiums. Coverage is not retroactive to the month of birth except in the case of a newborn, which shall be added the first of the month of birth.
  • A newborn’s Social Security number is not required at the time of initial enrollment, but must be provided when received from the Social Security Administration.

Accepting the Newborn Limited Benefit when not enrolling the newborn:

  • There is no additional premium for the Newborn Limited Benefit.
  • The Newborn Limited Benefit is subject to applicable plan annual deductible, copayments, coinsurance and plan limitations. Employees are responsible for any charges over and above the Newborn Limited Benefit regardless of the facility’s network or non-network status. Refer to each plan for specific plan details. 
  • Enrollment of other eligible dependents is not required.
  • The Newborn Limited Benefit applies only if the mother or father of the newborn is covered under an EGID health plan.

Plan details:

HMOsBlueLincs HMO, CommunityCare HMO and GlobalHealth HMO – A newborn is covered for 31 days without an additional premium.

HealthChoiceA newborn has limited coverage for a routine birth for the first 48 hours following a vaginal delivery or for the first 96 hours following a C-section delivery without an additional premium.

  • There are no benefits for services in addition to a routine hospital stay if the newborn is not enrolled and premiums are not paid for the month of birth.
  • The member is responsible for any charges over and above the Newborn Limited Benefit regardless of the facility’s network or non-network status. A separate calendar year deductible and coinsurance apply.

NOTE: If the employee’s spouse also works for an EGID-recognized employer with health coverage provided by EGID, they should consult both plan carriers before opting for the Newborn Limited Benefit. Some providers may not be in network for all plans. It is important to confirm network coverage is available. 

Declining the HealthChoice Newborn Limited Benefit

To decline the Newborn Limited Benefit, a Newborn Limited Benefit Waiver must be completed. This action is not recommended.

Divorce

Oklahoma law prohibits dropping a spouse or dependent from coverage while in the process of a divorce or legal separation at any time. It is important employees contact their legal counsel for advice before making any changes to their coverage. Refer to Oklahoma statute 43 O.S. § 110.

If an employee is court-ordered to provide (pay for) insurance for a former spouse, the former spouse is not an eligible dependent and cannot enroll in or keep coverage under the employee through EGID.

A former spouse covered by the employee as a dependent at the time of the final divorce decree is eligible for coverage under COBRA. A former spouse is not eligible for COBRA coverage through EGID if they were not covered at the time of the final divorce decree.

DHS-directed dependent additions (National Medical Support Notice)

You may receive a document called a National Medical Support Notice, which is a court order requiring an employee to insure one or more of their children. This notice includes the following parts:

  • Part A – Notice to Withhold for Health Care Coverage (your part).
  • Part B – Medical Support Notice to Plan Administrator (EGID’s part).

You are required to complete the employer response in Part A and return it to the issuing agency. You are also required to forward Part B to the plan administrator (EGID). You do not complete Part B. The employee may be required to add additional benefits or change carriers when they receive this notice. Please do not make changes to the employee’s coverage through web enrollment in response to this notice.

Our web support unit handles all National Medical Support Notices. When EGID receives Part B, we make the appropriate changes to the employee’s coverage and contact you to review them. All changes to coverage are effective the first day of the month following receipt of the notice. Please forward Part B to:

EGIDAttn: Web SupportP.O. Box 58010Oklahoma City, OK 73157-8010

Surviving dependents

In the event of an employee’s death, please complete and return an Insurance Termination Form to EGID, and we will mail a survivor packet to all eligible dependents. To continue coverage, a surviving spouse and dependents have 60 days following the employee’s death to complete and return the Surviving Spouse and Dependent Election Form. Coverage is effective the first day of the month following the employee’s death.

  • A surviving spouse is eligible to continue coverage as long as premiums are paid.
  • Surviving dependent children are eligible to continue coverage until age 26.
  • Disabled dependent children are eligible to continue coverage as long as they meet the EGID definition of a disabled dependent.
  • If a survivor is age 65 or older, they must enroll in a Medicare supplement plan.
  • Premium Notices are sent to the survivors’ addresses, and premiums must be paid through the last day of active coverage.

NOTE: A surviving spouse is billed the primary member rate and dependent children are billed the appropriate dependent rate. When an adult is not listed as the primary member, each surviving dependent child is enrolled under a separate account and billed the child premium.

Transfer employees

A transfer employee is someone who moves from one EGID participating employer to another. The break in coverage cannot be more than 30 days. A transfer employee is treated as a new employee with the following options:

  • Enroll with coverage effective the first month of employment if the previous coverage ended the month prior. The employee is responsible for paying plan premiums for this first month of coverage.
  • Continue coverage through their previous employer for one month until they are eligible to enroll through the new employer.
  • Enroll in COBRA coverage for the gap in coverage.
  • Enroll in the Guaranteed Issue amount of life insurance.
  • Continue any amount of life insurance they had through their previous employer without a life insurance application.

If your employee transfers to another employer, you must terminate their current coverage immediately. Failure to terminate their account in a timely manner can result in a gap in coverage and possible payroll deduction errors with the new employer.

Returning to work after leaving employment

If a previous employee returns to work for your employer after a break of less than 30 days, they are eligible to enroll in only the coverage they had in effect when they left employment.

If a previous employee returns to work for your employer after a break of 30 days or more, enroll them as if they were a new hire, except for life insurance. If the employee returns within 24 months, they can enroll in only the amount of life insurance they had when their previous employment ended unless a life insurance application is approved for a greater amount of coverage. However, the total amount of life insurance cannot exceed the Guaranteed Issue amount based on the employee’s current salary unless a life insurance application is approved.

If the returning employee is retired, they can elect the employer group coverage or continue coverage as a former employee. If they are on Medicare, the following applies:

  • If an employee elects the employer group health coverage, they must contact Medicare before the new coverage begins. They also need to contact Medicare when they terminate employment.
  • If an employee chooses to keep coverage as a former employee, Medicare continues to be the primary payer.

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