Eligibility and Enrollment
Proof of Eligibility Requirements
Documentation Required for Proof of Eligibility (PDF)
Affidavit to confirm marriage (Employee) (PDF)
Affidavit to confirm marriage (Spouse) (PDF)
Impaired (Disabled) Dependent – Certificate of Impairment Form (PDF) – For impaired dependent over age 26
Attending Physician’s Statement of Impairment (PDF) – For impaired dependent over age 26
Spousal Employer Verification Form – OHP-KIPP (PDF)
Initial (New Hire) Enrollment
You are eligible to enroll in the Plan if you work for a participating employer and you are a member of a group of employees designated by your participating employer as eligible to participate.
To enroll in the Plan, you must enroll online within 31 days of your hire date. If you do not enroll within the time frame, you must wait until the next open enrollment period or until you experience a qualifying event. Participation is optional, but to decline your insurance benefits you are required to complete a waiver online. The start of coverage depends on your contract with your employer.
Dependent Enrollment and Eligibility
A Spouse and dependent children (up to the age of 26) who meet the Plan’s eligibility criteria are able to enroll in the Ohio Healthcare Plan (OHP) for medical and dental coverage. .
Spouses that are eligible for enrollment may enroll in OHP for secondary coverage when they are primary on another plan. For a Spouse to enroll in this Plan for primary medical coverage, the Spouse must meet the criteria eligibility listed here Eligibility Requirements for a Spouse to Enroll in Medical Plan.
As part of the enrollment process, you will be required to answer the spousal questions located in the Benelogic system. If your Spouse is eligible to be secondary, their primary insurance information will need to be entered in the Coordination of Benefits (COB) section of the enrollment process.
If your Spouse is employed but does not have access to an employer-sponsored medical plan, you will be required to have your Spouse’s employer complete the Spousal Employer Verification Form. Print the form from either this site or from the Resources Tab in the enrollment portal, complete, and upload to your Benelogic file cabinet
Making Changes to Your Medical or Dental Plan Enrollment Mid-Year
You may make changes throughout the year if you have a qualifying event or family status change. You must make the change at ohp.benelogic.com within 31 days after the qualifying event (and within 60 days to enroll a newborn). If you go beyond the time limit, you must wait until the next open enrollment period to make changes or additions.
Examples of a qualifying event (family status change)
- Divorce or Legal Separation
- Loss of coverage (not dropping coverage voluntarily)
- Loss of coverage under a Medicaid plan or a state CHIP program
- Qualified Child Medical Support Order (QCMSO)
- Legal Guardianship
- Newborn and Adoption
Reference the official OHP documents for complete eligibility requirements for coverage under the plans for you and your dependent spouse and children. If there is any discrepancy between this information and the official OHP documents, the official document will control.
Annual Open Enrollment
Each year you have the opportunity to participate in the Medical Plan for the first time, change plan options, or add or drop dependents without a qualifying event. Your Treasurer or Personnel Department will provide Open Enrollment online instructions to you. Open Enrollment occurs in the fall of each year with coverage effective January 1 of the following year.
During the designated open enrollment time period, review the Open Enrollment Benefits Booklet provided by your Employer to guide you through your online enrollment. Login to the Employee portal at ohp.benelogic.com
Remember that your health plan allows you to have your premiums deducted pre-tax. As a result the plan is considered a “cafeteria plan”, and is subject to IRS cafeteria plan regulations. Under these regulations employees cannot drop coverage at any time unless is during the plan’s open enrollment period, or within 31 days of a status change or qualifying event.
Please contact AST@planmanagementservice.com