SCDC POLICY/PROCEDURE

TITLE: STATE EMPLOYEE GROUP BENEFITS

ISSUE DATE:  JULY 1, 2004

PURPOSE: To provide employees with information regarding state employee group benefits.

1. STATE GROUP BENEFITS:

1.1  All SCDC employees occupying a full-time (37.5 or 40.0 hour) permanent position or part-time permanent position scheduled to work at least 20 hours (effective January 1, 2004) for more than six (6) months out of any calendar year are eligible for State Group Benefits. (3-ACRS-1C-02, 3-ACRS-1C-08, 3-4048, 3-4063)

1.2  Consistent with the State Group Benefits Administrator's Manual for South Carolina State and Public School Employees, employees may elect coverage for eligible dependents and covered entities at the time of hire; during designated enrollment periods; within 31 calendar days of a family status change; and during each open or annual enrollment.  

1.3  All premiums will be established by the State Employee Insurance Program (EIP) based on the level of coverage.

1.4  Employees may refuse any or all plans if they choose at the time of hire or during designated enrollment periods. Refusing coverage for health benefits also includes loss of the State Group Life Insurance and Long Term Disability (LTD) benefits provided by the State.

1.5  Employees may refuse coverage for Standard Optional Life, if not on MoneyPlus, and/or Dependent Life at any time and apply at a later time; however, a "Personal Health Statement" (available through the Division of Human Resources) may be required to be completed and prior approval must be given by the carrier before the coverage becomes effective.

2. TYPES OF COVERAGE/BENEFITS:

2.1  State Health Plan: The State Health Plan (administered by Blue Cross and Blue Shield) offers two (2) health plans: Economy Coverage and Standard Coverage. The State Health Plan is available to employees throughout the state. Participating in the state health program also provides the employee with Long Term Disability benefits and State Group Life Insurance. (Refer to the Insurance Benefits Guide available through the Division of Human Resources for an explanation of benefits.)

2.2  Health Maintenance Organizations (HMO): The state offers an alternative to the State Health Plan whereby an employee may elect an HMO of his/her choice based on whether s/he lives or works in a service area designated by the HMO. Participating in an HMO also provides the employee with Long Term Disability benefits and State Group Life Insurance. (Refer to the appropriate HMO handbook available through the Division of Human Resources for an explanation of benefits.)

2.3  Dental: An employee may elect dental coverage for him/herself and for other eligible dependents as outlined in Sections 3., and 4., below.

2.4  Dependent Life:  Active employees may enroll eligible children for $10,000 dependent life coverage at anytime without medical evidence of good health.  Active employees may enroll spouses in dependent life coverage with medical evidence of good health in $10,000 increments up to half the employee's optional life coverage or $100,000, whichever is less.  Dependent Life spouse or child coverage may be dropped at anytime.

2.5  Optional Life: A new employee may elect optional life insurance without medical evidence in increments of $10,000 up to three (3) times the basic annual salary rolled down to the nearest $10,000 increment up to $500,000, whichever is less.  A new employee may request a level greater than three (3) times the annual salary to the maximum of $500,000 with medical evidence of good health.  Employees who do not elect coverage or who do not elect the maximum coverage at the time of hire must complete a Personal Health Statement (available through the Division of Human Resources) to participate in optional life or to increase their optional life coverage except within 31 days of a special eligibility situation.  Employees  who  have  their  optional  life  under  the  MoneyPlus Plan must wait until annual/open enrollment to change coverage.  If an employee does not have their optional life under the MoneyPlus Plan, they may request an increase in coverage at any time.   Insurance premiums for optional life insurance are based on an employee’s age. (For additional information, refer to the Optional Life chapter of the Insurance Benefits Guide.) 

2.6  Supplemental Long Term Disability (SLTD): SLTD insurance is offered to all new hires without medical evidence within the first 31 calendar days of employment. All other employees may apply with medical evidence of good health and must await approval from the contracted provider. Employees may elect one (1) of two (2) plans (one [1] plan carries a 90 calendar day waiting period, the other a 180 calendar day waiting period). Benefits are payable if the elimination period is met. (Refer to the Insurance Benefits Guide available through the Division of Human Resources for further information.)

2.7  Money Plus Program: This plan offers all state employees the option to reduce the amount of taxable income by the amount of premiums paid for Optional Life (up to $50,000 coverage), health, and dental insurance. Employees may elect to additionally reduce their taxable income through the Money Plus Program by participating in Dependent Day Care and Out-Of-Pocket Medical Spending Account. 

2.8  Long-Term Care (LTC): Long-Term Care (LTC) provides a daily benefit for home or nursing facility care or adult day care based on elected coverage. Employees may elect LTC coverage for themselves, spouse, parents, and in-laws. Units of coverage may be elected, but no less than three (3). To cover a spouse, a parent(s), or an in-law(s), employees must cover themselves. (For specifics on this coverage plan, see your Human Resources Manager/Liaison.)

3. RULES FOR ENROLLMENT:

3.1  New Hires: New employees enrolling in a state group benefit must make written application by completing a "Notice of Election (NOE)" form (available through the Division of Human Resources) for each elected benefit. This will be accomplished on their first day of pre-processing. New employees may elect to change their decision within 31 calendar days of their hire date. Should a new hire choose not to participate in a state group benefit, s/he must sign a NOE form refusing the benefits. 

3.2  Family Status Change: Should a family status change occur that necessitates a change in coverage, an employee may add or delete dependents within 31 calendar days of the status change by completing a NOE form and by providing any necessary documentation (see below). Otherwise, the employee must wait for the next designated open enrollment period.

3.2.1  Spouse Losing or Gaining Coverage: A letter must be provided by the gaining or losing employer indicating the gain or loss of coverage, employee’s name and social security number, spouse's name and social security number, type and level of coverage, dependents covered, carrier's name, plan number, group number, date coverage gained or lost, and reason coverage terminated. This information must be provided on letterhead; the documentation must be signed by the appropriate personnel; and a phone number must be provided for verification. An employee may add a family member(s) to his/her health plan only within 31 calendar days of losing or gaining coverage or within 31 calendar days of a family status change or occurrence.

3.2.2  Divorce or Legal Separation: In the case of divorce, an employee must drop his/her ex-spouse. In the case of separation, an employee may drop his/her spouse upon providing a written statement from his/her attorney or from the Court indicating that s/he has applied for separation or divorce. Should an employee be ordered by the Court to cover the ex-spouse, the employee must provide a copy of the Court Order. However, if insuring an ex-spouse, the employee cannot simultaneously insure a present spouse or vice versa. An employee may add family to his/her health plan only within 31 calendar days of losing or gaining coverage or within 31 calendar days of a family status change or occurrence.

3.2.4  Birth and Marriage: An employee may add a newly acquired dependent(s) (child(ren) or spouse) by completing a NOE form within 31 calendar days of the occurrence.

3.2.5  Adoption/Guardianship/Conservatorship: An employee may add or delete dependents from coverage by completing a NOE form and providing Court-Ordered documents or placement papers within 31 calendar days of occurrence.

3.3  Annual/Open Enrollment: The Division of Human Resources will notify Agency employees prior to each annual/open enrollment period.

3.4  A "Personal Health Statement" (available through the Division of Human Resources) may be used to enroll or change coverage to the maximum level at any time, for optional life if not on MoneyPlus, dependent life, or supplemental long term disability coverage. An employee who has his/her optional life coverage by MoneyPlus must wait until annual/open  enrollment  and  provide  a  personal  health  statement.

3.5  Pre-existing Conditions: A covered person does not receive a benefit for a medical condition if s/he receives medical advice, an actual diagnosis, care, or treatment from a licensed health care provider within six (6) months prior to enrollment in the plan. Benefits for a pre-existing condition are payable only for treatment rendered 12 months after the enrollment date of a covered person, or 18 months after the enrollment date for a late entrant, provided that creditable coverage without a break in coverage of greater than 62 days prior to the enrollment date is applied toward the waiting period for services related to a pre-existing condition to be payable. Pregnancy does not constitute a pre-existing condition. (Refer to the Insurance Benefits Guide for details.)

4.  RULES FOR ELIGIBILITY FOR DEPENDENTS:

4.1  Spouse: Only an employee's lawful spouse or former spouse (if required to be covered by divorce decree or Court Order) is eligible, but not both. If both the employee and spouse are employed by the State, school district, or covered entity, then an "Election of Benefits" form must be completed through their respective employers to ensure that there is no duplication of coverage.

4.2  Children: An employee's natural or adopted child, step-child, foster child, or a child for whom s/he has legal custody, and the employee's grandchild for whom s/he has legal custody and who resides in the employee's home in a parent-child relationship or for whom the subscriber provides support and maintenance because of a court order, are eligible for any health, dental, or life insurance benefits.

4.3  Parents/Grandparents: Neither the parents nor grandparents of an employee, whether living in the employee's home and/or being supported by the employee, are eligible for any health, dental, or life insurance benefits.

5.  INELIGIBILITY OR PROOF OF ELIGIBILITY:

5.1  Age: Coverage ends the first of the month after an eligible dependent child reaches age 19, unless s/he is a full-time student. If a dependent child is a full-time student, certification is required unless the dependent is incapacitated, as follows:

5.1.1  Student Certification: An employee may cover an eligible dependent between the ages of 19-24 who is a full-time student at initial enrollment with the  employee’s name and social security number and student's name and social security number.  A "Student Certification" form (available through the Division of Human Resources) must be completed to certify the student’s full-time status.  Approximately 90 days prior to a currently enrolled dependent child's 19th birthday, the employee will receive a student certification form letter, which must be completed and submitted along with verification of student status (on letterhead) from the school.  Re-certification may not be required after initial certification; however, random periodic audits will be conducted for students where parents will be asked to verify student status.  

5.1.2  Incapacitated Child(ren): An employee covering an incapacitated child(ren) must provide a complete statement of eligibility by the dependent child's attending physician within 31 calendar days of enrollment. To be eligible for coverage based on incapacitation, the child must be incapacitated prior to age 19 or, if s/he is a student who becomes incapacitated between ages 19 and 25, s/he must be approved prior to his/her 25th birthday. The incapacitation must be permanent.  

5.2  Marriage of Dependent Child: Coverage ends on the first of the month after the date of marriage of a covered dependent and cannot be reinstated with a divorce.

5.3  Divorce: Coverage for a spouse terminates the first of the month after a divorce becomes final, unless the employee is required by Court Order to carry coverage.  Employees are required to provide a copy of the page(s) of the Court Order that specify the required coverage for conservatorship, guardianship, custody, divorce, adoption, separation, foster child, or grandchild or child for whom the employee must provide support and maintenance or have legal custody.

5.4  Name Certification: A single or married employee insuring a spouse and/or child(ren) with a different last name must complete a "Certification for Spouse/Children (different last name)" form (available through the Division of Human Resources).

6.1  New Hire: The effective date of coverage will be the first of the month after an employee’s date of hire unless his/her hire date is the first working day of the month, in which case the effective date of coverage is decided upon by the employee by selecting the first day of the month of the date of hire or first of coming month.

6.2  Birth, Marriage, Adoption, or Death: The effective date of coverage will be the date of the occurrence or, in the case of death, one (1) day after the date of death for health, dental, and LTC.

6.3  Family Status Change: The effective date of coverage will be based on special eligibility situations such as marriage, birth, adoption, loss of coverage, etc. Requests to add/delete dependents must be made within 31 days of the qualifying event. A "Notice of Election" form (available through the Division of Human Resources) will be used by employees for this purpose.

6.4  Annual Enrollment: Annual enrollment occurs each even year and open enrollment occurs every odd year during the month of October.  Employees will be advised of changes available during each enrollment period.  Any changes will be effective on January 1 of the next calendar year. 

6.5  Dependent Life Insurance: The effective date of coverage will be the first of the month after initial enrollment, unless there is an application approved with medical evidence, in which case the effective date of coverage is the first of the month following approval.

6.6  Optional Life Insurance:  Premiums will be based on age and selected coverage amount. The effective date of coverage will be the first of the month after initial enrollment or will be effective upon approval from the carrier.

6.7  Medical Evidence Approvals: Coverage will begin on the first of the month following approval by the carrier. 

7.  COLLECTION OF PREMIUMS:  All employees are responsible for paying premiums for their elected state group coverage(s) based on the information provided in their completed Notice of Election form. Premiums will be payroll deducted according to rates provided by the State Employee Insurance Program and the effective date(s) of coverage. Employees on leave without pay will be responsible for paying their monthly premiums as billed by the Division of Human Resources, Benefits Branch, to include employee/employer portion. If an employee is on workers’ compensation or on Family Medical Leave, the employee will be responsible for the employee portion only. Employees on an agency approved furlough are responsible for their state group premiums as defined in the program guidelines.  Should a refund be necessary due to premium overpayment, the Benefits Section will request the refund through the State Employee Insurance Program.

8. COBRA (Consolidated Omnibus Benefits Reconciliation Act): Any employee or dependent who loses his/her health/dental coverage as a result of terminating employment or a family status change, e.g., divorce, marriage, age limits, employment, loss of student status, etc., is eligible to make application within 60 days of the date of occurrence to continue his/her health and/or dental coverage at the same level at the time of loss. Length of coverage will be as follows:

8.1  Employee(s): 18 months for those who are involved in a reduction in force or who have terminated employment; 29 months if proof of disability is provided by Social Security within their first 18 months of coverage.

8.2 Dependents: 36 months for dependent children who have lost benefits due to age limits or who no longer meet the definition of a dependent child (e.g., a child who is between the ages of 19-24 and has completed school), or a spouse who is separated, divorced, or in non-payment status of the required premium (e.g., if a spouse has stopped paying insurance premiums, the other spouse and his/her children may be covered under COBRA). Extension may apply to a disabled and incapacitated dependent.

9. DEATH OF AN EMPLOYEE:

9.1  When the death of an employee occurs, the immediate supervisor should notify the appropriate  Division Director or Warden, who will then notify the Division Director of Human Resources or designee, the Chief, Pastoral Care Services Branch, the appropriate member of the Director's staff, and the Agency Director.         

9.2  Upon notification of the death, the Division Director of Human Resources or designee will:

9.2.1  notify the South Carolina State Retirement System, State Employee Insurance Program, and provide assistance with other benefits upon request; (NOTE: The deceased employee’s court appointed representative or beneficiary should receive a copy of all appropriate correspondence.)

9.2.2  arrange a suitable time at the beneficiary’s request for a personal meeting to discuss benefits and to complete any necessary documents;

9.2.3  file Death Claims on behalf of employees for state group benefits, i.e., basic life, optional life; and

9.2.4  forward any check(s) to the employee's designated beneficiary or court appointed representative by Certified Mail, Return Receipt Requested or deliver it in person.

9.3  For additional information on benefits afforded the family of an employee killed in the line of duty, see SCDC Policy/Procedure ADM-11.38, "Employee Deaths, Catastrophic Injuries, and Survivor Assistance."

Annual Enrollment refers to a specified period designated by the State Employee Insurance Program whereby employees may make application for insurance plan changes to be effective January 1st of the following year.

Dependent(s) refers to an employee's spouse (married or common law), and/or any unmarried, unemployed, natural, or adopted child(ren), and/or any child of the employee or spouse under the age of 19 for whom the employee provides legal guardianship, conservatorship, or maintenance or support based on a Court Order. If a dependent child is between 19-24 years of age, the dependent must be an unmarried full-time student or an incapacitated child. Certification of either status will be required as described in Sections 5.1 through 5.1.2.

Open Enrollment refers to an a specified period designated by the State Employee Insurance Program held every two (2) years whereby employees may enroll/disenroll in health/dental plans and add/delete dependents to be effective January 1st of the following year.

State Group Benefits refer to those insurance and benefits programs afforded SCDC employees, to include: complete health, dental, life, dependent life, supplemental long term disability (SLTD), optional life, Long Term Care (LTC), and MoneyPlus. Consistent with state statutes governing competitive bids and the term of contracts for goods and services, the carriers for such benefits may vary from year to year.

SIGNATURE ON FILE