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When Georgia Health Insurance Coverage Begins

When Coverage Begins

This section includes information about:

How to enroll.
If you are hospitalized when this coverage begins.
Who is eligible for coverage.
When to enroll.
When coverage begins.

How to Enroll

To enroll, the eligible Employee should contact your Payroll location for instructions on enrolling within 31 days of hire. SHBP will not provide benefits for health services that you receive before your Effective Date of coverage.

If You Are Hospitalized When Your Coverage Begins

If you are Inpatient in a Hospital, Skilled Nursing Facility or inpatient rehabilitation facility on the day your coverage begins, SHBP will pay benefits for covered health services related to that inpatient stay as long as you receive covered health services in accordance with the terms of the Plan.

You should notify Blue Cross Blue Shield of Georgia within 48 hours of the day your coverage begins, or as soon as reasonably possible. In-network benefits are available only if you receive covered health services from contracted providers.

Who is Eligible for Coverage
Who	Description	Who Determines Eligibility
Eligible Employees	You are eligible to enroll yourself and your eligible Dependents for coverage if you are: A full-time Employee of the State of Georgia, the General Assembly or an agency, board, commission, department, county administration or contracted Employer that participates in SHBP, as long as: You work at least 30 hours a week consistently, and Your employment is expected to last at least nine months. (Not Eligible: Student Employees or seasonal, part-time or short-tem Employees.) A certified public school teacher or library Employee who works halt-time or more, but not less than 17.5 hours a week. (Not Eligible: Temporary or emergency Employees.) A non-certified service Employee of a local school system who is eligible to participate in the Teachers Retirement System or its local equivalent. You must also work at least 60% of a standard schedule for your position, but not less than 20 hours a week. An Employee who is eligible to participate in the Public School Employees' Retirement System as defined by Paragraph 20 of Section 47-4-2 of the Official Code of Georgia, Annotated. You must also work at least 60% of a standard schedule for your position, but not less than 15 hours a week. A retired Employee of one of these listed groups who was enrolled in the Plan at retirement and is eligible to receive an annuity benefit from a state-sponsored or state-related retirement system. See Provisions for Eligible Retirees for details of retiree medical coverage. An Employee in other groups as defined by law.	SHBP determines who is eligible to enroll under the Plan.
Dependent	Eligible Dependents are: Your legally married Spouse; as defined by Georgia law. Your never-married Dependent children who are: Naturally or legally adopted children under age 19, unless they are eligible for coverage as Employees. Children that are legally adopted through the judicial courts become eligible only after they are placed in your physical custody. Stepchildren under age 19 who live with you at least 180 days per year and for whom you can provide documentation satisfactory to the Plan that they are your Dependents. Other children under 19 if they live with you permanently and legally depend on you for financial support - as long as you have a court order, judgment or other satisfactory proof from a court of competent jurisdiction. Your natural children, legally adopted children or stepchildren 19 or older from categories 1 and 2 above who are physically or mentally disabled prior to reaching age 19 and who depend on you for primary support may continue their existing Plan coverage pas age 19. Your natural children, legally adopted children, stepchildren or other children age 19 to 26 from categories 1, 2 and 3 above who are registered full-time students at fully accredited schools, colleges, universities, or nurse training institutions and, if employed, who are not eligible for a medical benefit plant from their Employer. The number of credit hours required for full-time study status is defined by the school in which the child is enrolled. You have 31 days from the date of the qualifying event or the date of the request for coverage, whichever is later, to provide qualifying event documentation and/or Dependent verification.	SHBP determines who qualifies as a Dependent.
Dependent	You will be required to provide copies of certified documents such as a marriage license, birth certificate, adoption contract or judge-signed court order to verify your Dependent relationship. You have 31 days from the date of the qualifying event or the date of the request for coverage, whichever is later. The Plan has the right to determine whether or not the documentation satisfied Plan requirements. If verification cannot be made, the Dependent's coverage will be terminated retroactively to his or her coverage Effective Date. The Plan will make every effort allowable under the law to recover from the Participant any and all payments made by the Plan on behalf of an ineligible Dependent.	SHBP determines who qualifies as a Dependent.
Dependent	Documentation Required for Eligible Dependents Age 19 or Older Coverage does not continue automatically at age 19. Full-time students whose verification documentation is not submitted timely will not be eligible for coverage until the following open enrollment or a qualifying event occurs. This means that you will need to submit full-time student verification before coverage ends at age 19 and each subsequent year to keep the student's eligibility active. If you allow the student's coverage to lapse because verification documentation is submitted late, you will not be able to add the student to your coverage under the following open enrollment. Verification documentation must be submitted timely for a student to be covered under the Plan. Below described what you must do to request continued coverage as your child nears age 19.	SHBP determines who qualifies as a Dependent.
Dependent	For a Covered Dependent Age 19 & Older... ...and a full-time student under the age 26 You must: Update SHBP annually on student status by requesting a certification letter from the school's registrar and sending it with a Dependent Student Status Information Form to SHBP The certification letter must include: enrollment date(s) for both current and previous quarters or semesters number of credit-hours taken each quarter or semester enrollment status (full- or part-time) for each quarter or semester NOTE: Letters of acceptance can be submitted to temporarily extend coverage for students who graduate from high school in May and plan to attend college for the fall semester or students transferring between colleges.	SHBP determines who qualifies as a Dependent.
Dependent	For a Covered Dependent Age 19 & Older... ...and disabled as a covered SHBP Participant before age 19 You must: File a written request for continuation of coverage priorto the 19th birthday or within 31 days after the 19th birthday and provide satisfactory documentation ofdisability. When requested by the Plan, if you fail to re-certify your Dependent within 31 days of the request, your Dependent will no longer be eligible to be covered under the Plan. If you have a disabled child who is already age 19 when you enroll, the child is not eligible for coverage. However, if your disabled child loses coverage under another plan, you may apply for SHBP coverage on the child if the child were eligible for SHBP coverage on your child's 19th birthday. To apply, send the Plan a written request and documentation on your child's disability and loss of other coverage within 90 days of the Dependent's loss of coverage. You must be a Participant when application is made. A general note regarding documentation send to the Plan: While the Plan requires that coverage requests are made within a specific time period, the documentation required to support your request may be filed later, if necessary within the 31 days following the deadline to file the coverage request.	SHBP determines who qualifies as a Dependent.
Dependent	Qualified Medical Child Support Order (QMCSO) SHBP will honor a QMCSO for eligible Dependents. A QMCSO creates, recognizes, or assigns the right for a Dependent to receive benefits under a health plan.	SHBP determines who qualifies as a Dependent.
Dependent	Who's Not Eligible for Dependent Coverage The most common examples of persons not eligible for SHBP Dependent coverage include: Your former Spouse Your Fiance Your parents Married or formerly married children Children age 19 or older who do not qualify as full-time students or disabled Dependents Children 26 or older who are not already covered as a disabled Dependent Children in military service Grandchildren who cannot be considered eligible Dependents Stepchildren who do not live in your home at least 180 days per year Anyone living in your home that is not related by marriage or birth, unless otherwise noted.	SHBP determines who qualifies as a Dependent.

Coverage by Region:

Resources:

Articles:

Gerogia Consumers Guide to Health Insurance:

Links: