Eligibility and Enrollment
Proof of Eligibility Requirements
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.
Special Eligibility Requirements for Spouses in Medical Plan Only
Spouses who are eligible for another employer-sponsored medical plan or retiree group medical plan, such as STRS or SERS, must take that coverage on an individual basis as primary insurance in order to be covered with Ohio Healthcare Plan for secondary insurance.
In order for spouses to enroll in the Ohio Healthcare Plan for primary medical and dental coverage, they must meet one of the following criteria:
- The spouse is also eligible for the Ohio Healthcare Plan through his/her participating school.
- The spouse is not eligible for an employer-sponsored medical plan or retiree medical plan.
- The other coverage would cost the spouse more than 50 percent of the total premium for single coverage of the lowest cost plan.
- Premium does NOT include spousal incentives or other such additional compensation, etc. forfeited upon enrollment in their own plan.
During your enrollment process in the Spousal Eligibility section of the Employee Portal, you will select the scenario which best describes your spouse’s eligibility. Your spouse’s employer will only have to complete a Spousal Employer Verification Form if employer does not offer health care coverage or requires you to pay more than 50 percent of the premium. If your spouse is already enrolled in his/her employer’s medical plan, you do not need to complete the verification form.
Dependent Children’s Enrollment
Eligible children include those up to age 26 for the Medical and Dental Plan.
For disabled dependent over age 26, use Disabled Dependent Certification (PDF).
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