Learning How to Join the Lumenos Georgia 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.