Health, Vision, Dental and Life Insurance
Jenks Public Schools participates in Health, Dental, Vision and Life Insurance plans offered by
the Employees Group Insurance Division (EGID)
of the Office of Management & Enterprise Services (OMES), of the State of Oklahoma.
Option Period Enrollment (usually the end of September through mid-October) – Coverage effective January 1st
This is the time when eligible employees can:
- Enroll in coverage.
- Change plans or drop coverage.
- Increase or decrease life coverage.
- Add or drop eligible dependents from coverage.
You can enroll in health, dental, life and/or vision coverage for yourself and/or your dependents during the annual Option Period, as long as you have not dropped that coverage within the past 12 months. If you have dropped coverage within the past 12 months without a midyear qualifying event, you cannot reinstate that coverage for at least 12 months.
Initial Enrollment – Coverage effective the first of the month following employment date
This is the time when new employees are eligible to:
- Enroll in coverage.
- Enroll eligible dependents.
- Apply for life insurance coverage above Guaranteed Issue by submitting a Life Insurance Application for review and approval.
As a new employee, you have 30 days from your employment or eligibility date to enroll in coverage. If you do not enroll within 30 days, you cannot enroll until the next annual Option Period, unless you experience a qualifying event. You have 30 days following your eligibility date to make changes to your original enrollment.
HIPAA Special Enrollment Rights
If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 30 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage). In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 30 days of the marriage, birth, adoption, or placement for adoption.
Midyear plan changes are allowed only when a qualifying event, such as birth, marriage or loss of other group coverage, occurs. You must complete the appropriate form within 30 days of the event.
- You must be a current education employee eligible to participate in the Oklahoma Teachers Retirement System working a minimum of four hours per day or 20 hours per week or other eligible employee regularly scheduled to work at least 1,000 hours a year, and not classified as a temporary or seasonal employee.
- You must be enrolled in a group health plan to enroll in dental and/or life insurance.
- If one eligible dependent is covered, all eligible dependents must be covered. Exceptions apply (refer to Excluding Dependents from Coverage in this section).
- Eligible dependents include:
- Your legal spouse (including common-law).
- Your daughter, son, stepdaughter, stepson, eligible foster child, adopted child or child legally placed with you for adoption up to age 26, whether married or unmarried.
- A dependent, regardless of age, who is incapable of self-support due to a disability that was diagnosed prior to age 26. Subject to medical review and approval.
- Other unmarried dependent children up to age 26, upon completion and approval of an Application for Coverage for Other Dependent Children. Guardianship papers or a tax return showing dependency can be provided in lieu of the application.
- If your spouse is enrolled separately in one of the plans offered through EGID, your dependents can be covered under either parent’s health, dental and/or vision plan (but not both); however, both parents can cover dependents under Dependent Life.
- Dependents who are not enrolled within 30 days of your eligibility date cannot be enrolled until the next annual Option Period, unless a qualifying event such as birth, marriage or loss of other group coverage occurs. Dependent coverage can be dropped midyear with a qualifying event.
- Dependents can be enrolled only in the same types of coverage and in the same plans you elect.
- To enroll your newborn, the appropriate form must be provided to within 30 days of the birth. This coverage is effective the first of the birth month. If you do not enroll your newborn during this 30-day period, you cannot do so until the next annual Option Period. Direct notification to a plan will not enroll your newborn or any other dependents. The newborn’s Social Security number is not required at the time of initial enrollment but must be provided once it is received from Social Security. Insurance premiums for the month the child was born must be paid.
- Without enrollment:
- HealthChoice – A newborn is covered only for the first 48 hours following a vaginal birth or the first 96 hours following a cesarean section birth. Under the HealthChoice plans, a separate deductible and coinsurance apply.
- Aetna, BlueLincs, CommunityCare, and GlobalHealth HMOs – A newborn is covered for 31 days without an additional premium.
Excluding Dependents from Coverage
- You can exclude your spouse from health and/or dental coverage while covering other dependents on these benefits. Your spouse must sign the Spouse Exclusion Certification section of your enrollment or change form.
- You can exclude dependents who do not reside with you, are married, are not financially dependent on you for support, have other group coverage or are eligible for Indian or military health benefits.
Note: Your spouse cannot be excluded from vision coverage if your other dependents are covered unless your spouse has proof of other group vision coverage. You must always provide proof of other group coverage when excluding a dependent for that reason.
- You can keep your coverage continuous when you move from one participating employer to another as long as there is no break in coverage that lasts longer than 30 days. Premiums must be paid upon reporting to work.
- Benefit options vary from employer to employer. Changes to your coverage must be made within the first 30 days of your transfer.
Termination of Coverage
- Coverage will end the last day of the month in which a termination event occurs, such as:
- Loss of employment.
- Reduction in hours.
- Loss of dependent eligibility.
- Non-payment of premiums.
COBRA – Temporary Continuation of Coverage
- The Consolidated Omnibus Budget Reconciliation Act (COBRA) allows you and/or your covered dependents to continue health, dental and/or vision insurance coverage after your employment terminates or after your dependent loses eligibility. Certain time limits apply to enrollment. Be aware, dropping dependent coverage during Option Period is not a COBRA qualifying event.
All newly hired, benefit eligible employees, must attend a New Hire Benefit Meeting and enroll in or waive benefits offered by the district.
For additional information contact the Insurance/Benefits Office:
Jaime Resendiz, x 2379
Mary Bell, x 2313
Flexible Benefit Allowance (FBA) and District Benefit Allowance (DBA) Information regarding allowances to help offset the cost of health insurance
Children's Health Insurance Program - CHIP Notice to employees regarding Premium Assistance under Medicaid and CHIP.
Affordable Care Act Marketplace Memo and Notice to Employees Health coverage options through the Health Insurance Marketplace.