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Coverage by Region

Georgia Health Insurance - Affordable Health Insurance Quotes in Georgia

Joining the Lumenos Health Insurance Plan


For specific information on joining the Lumenos plan, see:

  • Eligibility
  • Enrolling in the Lumenos plan
  • When Coverage Begins
  • Cost of Coverage

Eligibility


You and your dependent(s) may be covered under the Lumenos plan depending on your eligibility for benefits. For more information, see:

  • Your Eligibility
  • Dependent Eligibility


    • Your Eligibility

    You are eligible to enroll yourself and your eligible dependents in the Lumenos Program on the first day of the month following one full calendar month of employment if you meet the following criteria:
    • A full-time employee of the State of Georgia.
    • You work at least 30 hours a week consistently and your employment is expected to last at least nine months.

    Dependent Eligibility

    You can also choose to cover your eligible dependents under the Lumenos plan. Eligible dependents include:

    • Your legally married spouse (as defined by the State of Georgia)
    • Your unmarried child who is under 19 years of age 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 age 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 past age 19.
    • Your natural children, legally adopted children, stepchildren or other children ages 19 through 25 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 plan from their employer. The number of credit hours required for Full-time Student status is defined by the school in which the child is enrolled

    If an unmarried child reaches age 19 and is not a full-time student, you may continue coverage for that child if he or she meets the criteria listed below prior to age 19:

    • incapable of self-support due to mental retardation or a physical handicap
    • dependent on you for support and maintenance or dependent on other care providers for lifetime care and supervision

    You must provide proof of your child's incapacity to the State Health Benefit Plan within 90 days after coverage would otherwise terminate. The Plan administrator may ask for proof of incapacity and dependency at any reasonable time. While the Plan requires that coverage requests be made within a specific time period, the documentation required to support your request may be filed, if necessary, within 60 days following the deadline to file the coverage request.

    If your spouse also works for the State of Georgia, he or she may be covered as an employee rather than a dependent. If both parents are employees of the State of Georgia only one parent can cover the children.

Enrolling in the Lumenos Plan


If you want coverage under the Lumenos plan, you must enroll for this coverage by completing an enrollment form within 31 days of first becoming eligible and according to the process defined by the State Health Benefit Plan in the enrollment materials. Forms are available by contacting

If you have enrolled for dependent coverage, coverage for your eligible dependents is effective on the same date your coverage becomes effective.

NOTE: If you join the Lumenos plan at any time other than at the beginning of the Plan year January 1, 2006 the initial amount allocated to your HRA will be prorated based on the number of months left in the Plan year.

For additional information regarding the enrollment process, see:

  • ID Cards
  • Family Status Changes
  • Special Enrollment Period


    • ID Cards
    The Lumenos plan requires you to use an identification card to receive benefits. You will need to present the card each time you visit a health provider.

    When you visit providers who offer discounts and present your ID card, your claim - in most cases - will be submitted by the provider to the Claims Administrator. If you don't present your ID card, you may need to pay for services yourself and file a claim for reimbursement at a later date.

    When you visit providers who do not offer discounts, you should show your ID card and you may need to pay for services yourself and file a claim for reimbursement at a later date.

    Change in Status
    If you wish to change your Lumenos plan coverage due to an eligible Change in Status, you must request that change within 31 days of the event. If the change is because of birth, adoption or placement of a child for adoption, coverage will be retroactive to the date of the birth, adoption or placement for adoption. In all other circumstances coverage will be effective the later of the Plan's effective date or your enrollment after that date pursuant to the Plan's eligibility rules. If you do not request a change within 31 days, you will have to wait until the next enrollment period to change your coverage (unless you experience another Change in Status event).

    The following is a list of the applicable change in status events:
    • birth, adoption or the placement of a child for adoption
    • marriage
    • divorce or legal separation
    • death of a dependent
    • a dependent's losing or gaining eligibility
    • a change in employment status for you or your spouse that results in change in medical coverage for you or your dependents
    • you or your spouse enrolling (or losing coverage) in Medicare or Medicaid
    • a court order requiring you to cover an eligible dependent

    IMPORTANT! A qualified medical child support order (QMCSO) is a legal judgment, decree or order issued under a state domestic relations law. A QMCSO creates or recognizes the rights of a child to coverage for health care benefits.

    Under a QMCSO, you can be required to provide coverage to your eligible dependent children under this Plan.

    In order to qualify as a QMCSO, the order must meet specific requirements provided by the Plan Administrator. The Plan Administrator will notify you if any of your children are affected by a QMCSO. You may contact the Plan Administrator to request a free copy of the Lumenos plan's procedures used to determine whether a medical child support order is qualified.

    NOTE: Your newborn child is considered your dependent under the Lumenos plan immediately after birth until discharged from the hospital or 7 days old. If you want to continue coverage beyond that date, you must enroll within 31 days of the date of birth.

    Special Enrollment Period
    If you or an eligible dependent decline to participate in the Plan because of other health care coverage, you may have the opportunity to enroll in the Plan at a later date if you lose eligibility for the other coverage.

    At the time you decline Plan coverage, you must state, in writing, that your reason for declining coverage is because you or your dependents have other coverage. If, in the future you or your dependents lose eligibility for the other coverage, you may enroll in the Plan - including the Lumenos plan so long as you enroll within 31 days after the date the other coverage ends. You or your dependents are not eligible for special enrollment under this Plan if you lose coverage due to a failure to pay premiums, failure to enroll during annual enrollment or for reasons of fraud.

    If you enroll in the Lumenos plan through the Plan's special enrollment provisions, your Lumenos plan coverage will be effective on the later of the Plan's effective date or your enrollment after that date pursuant to the Plan's eligibility rules.

When Coverage Begins


The Lumenos plan coverage begins on the later of the Plan's effective date or your enrollment after that date pursuant to the Plan's eligibility rules.

Cost of Coverage


You and the company share the cost of the coverage you choose. Your cost for this coverage will be deducted from your pay each pay period on a before-tax basis. This means that your cost for coverage is taken from your salary before income and Social Security taxes are calculated. This reduces your taxable income and the amount of taxes you pay and the end result is that your take home pay is higher than it would be if you paid your share of coverage under the Plan with after-tax dollars.

Your salary contribution for the cost of coverage goes only to offset the employer's cost for the traditional health coverage component of the plan. No portion of your salary contribution goes into the Health Reimbursement Account.

For information on your specific contribution rates, contact your personnel/payroll office.

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