When to Enroll in Georgia Health Insurance

When to Enroll and When Coverage Begins

You must enroll to have SHBP coverage. To enroll, go to your personnel/payroll office for instructions. You will be asked to:

• Choose a coverage option
• Name the eligible Dependents you want to cover
• Name eligible Dependents you want to enroll

By enrolling, this authorizes periodic payroll deductions for premiums. If you list Dependent(s) you will be enrolled in family coverage. If you cover Dependents and do not provide documentation to verify them, you will be automatically changed to single coverage. Please refer to "Who is Eligible for Coverage" for more information. Once you make your coverage election, changes are not allowed outside the open enrollment period, unless you have a qualified change in status under Section 125 of the Internal Revenue Code, which restricts mid-year changes to coverage in the SHBP.

NOTE: If you terminate employment and are re-hired during the same Plan year, you must enroll in the same Plan option, provided you are eligible for that option.

Important Plan Membership Terms

The Plan uses these terms to describe Plan membership:

• Participant - You, the contract/policy holder
• Dependent - You and/or your eligible Dependents that you choose to enroll

Where appropriate, this SPD relies on these terms throughout the document:

• Employee, retiree or Participant - to refer to Participant
• Dependent(s) - to refer to Dependents

DCH Surcharge Policy

Spousal Surcharge:

A spousal surcharge will be added to your monthly premium if you elect to cover your Spouse and your Spouse is eligible for coverage through his/her employment but choose not to take it. If your Spouse is eligible for coverage with SHBP through his/her employment, the spousal surcharge will be waived. You will automatically be charged the surcharge if you fail to answer all questions concerning the surcharge. The surcharge will apply to your premium for Plan year 2008.

Note: The spousal surcharge can be removed in certain circumstances by completing the spousal surcharge affidavit and attaching the required documents. Details can be found on the Department of Community Health web site, www.dch.georgia.gov/shbp_plan.

Tobacco Surcharge:

A tobacco surcharge will be added to your monthly premium for Plan year 2008 if you or any of your Covered Dependents have used tobacco products in the previous twelve months. The tobacco surcharge may be removed by completing the tobacco cessation requirements. Details can be found on the Department of Community Health website, www.dch.georgia.gov/shbp_plans.

Initial Enrollment Period

The initial enrollment period is the first period of time when eligible Employees can enroll. Eligible Employees may enroll themselves and their Dependents. Enrollment must be completed within 31 days of your date of hire.

Open Enrollment Period

Open enrollment occurs every fall for the following plan year. Eligible Employees may enroll themselves and their Dependents. Any Dependent(s) removed during the open enrollment period are not eligible for COBRA.

The SHBP determines the open enrollment period. Coverage begins on the date identified by the SHBP if the SHBP receives the completed enrollment form and any required contribution within 31 days of the date the eligible Employee becomes eligible to enroll.

If you are:	You can enroll:	Your coverage takes effect:
A current Employee	or make coverage changes during open enrollment or make coverage changes within 31 days of a qualified changes in status upon loss of all eligible Dependents within 31 days	The upcoming January 1 First of the month following your request
A newly hired Employee	Within 31 days of your hire date	First of the month after a full calendar month of employment

Enrolling A Newly Eligible Dependent

If you have a new Dependent due to marriage, birth or adoption, you may enroll your Dependent if you request enrollment within 31 days of the marriage, birth or adoption. Please contact your personnel/payroll office for instructions.

The next section describes what you need to do if you wish to add a newly eligible Dependent.

If you have to enroll a newly eligible Dependent and...	You will need to:
You already have family coverage	You must add within SHBP within 31 days of the birth, marriage, or adoption
You have a court order, requiring you to enroll Dependent child(ren)	Enroll the eligible child(ren); coverage starts on first day of month following the request

*To make coverage retroactive to the child's birth or placement, you must make the appropriate coverage premium payment(s) for coverage for the month of the birth or adoption contract and placement.

Identification Cards

After you enroll, you will receive an Identification (ID) Card for yourself and eligible Dependent(s), if applicable. The ID care must be presented when care is received.

If you do not receive your ID card within two weeks of enrollment, please contact Blue Cross Blue Shield's Customer Services at 1-800-464-1367.

When Coverage Begins
For You When your coverage starts depends on when you enroll and when you make requests that affect your coverage.
If you enroll:	Your coverage begins:
During an open enrollment period	On January 1 of the new Plan year
As a new Employee	On the first day of the month following one full calendar month of employment
When you are reinstated or return to work from an unpaid leave of absence that occurred during the open enrollment period	On the first day of the month following the return or, if a judicial reinstatement, on the day specified in the settlement agreement
When you have a qualifying event	On the first day of the month following the request

Transferring Employees

If you are transferring between participating Employers:

• Contact your new Employer to coordinate continuous coverage
• You must continue the same coverage, unless you had a qualifying event that made you ineligible to continue that coverage

There is no coverage lapse when your employment break is less than one calendar month and your new Employer deducts the premium from your first paycheck.

For Your Dependents

As a new Employee, Dependent coverage begins when your coverage begins. If you add Dependents later, through a qualifying event, coverage takes effect as described in the chart below. As a new Employee, Dependent coverage begins when your coverage begins. If you add Dependents later, through a qualifying event, coverage takes effect as described in the chart below. You must also provide the following documentation within 31 days from the date of the qualifying event.

Adding Dependents
If you add this Dependent:	Coverage takes effect:
A baby Copy of a certified birth certificate or a certification letter of birth required upon request	On the first day of the month following the request; or On the day your child was born, if the family premium is paid from the birth month.
An adopted child Copy of certified adoption certificate required upon request	When you already have family coverage: On the date of legal placement and physical custody, if the family premium is paid from the time of placement and custody When you change to family coverage within 31 days of the event: On the date of legal placement and physical custody, if the family premium is paid from the time of placement and custody
A new Spouse Copy of certified marriage certificate required upon request	When you already have family coverage: On the day of your marriage When you have single coverage: On the first day of the month following the request
Stepchild(ren) Copy of certified birth certificate showing your Spouse is the natural parent; and copy of certified marriage license showing the natural parent is your Spouse; and notarized statement that Dependent lives in your home at least 180 days per year	When you have single coverage: On the first day of the month following the request When you already have family coverage: On the first day of the month following the request

NOTE: When you add a Dependent and the Plan requests Dependent verification documentation, you must submit the documentation requested by the Plan in order to cover the Dependent. If you fail to provide Dependent verification documentation on a timely basis, the Dependent will not be eligible for coverage until the following open enrollment or a qualifying event occurs.