Oklahoma Administrative Code › Title 260 - Office of Management and Enterprise Services › Chapter 50 - Employees Group Insurance Division - Health, Dental, Vision and Life Plans › Subchapter 3 - Administration of Plans › Section 260:50-3-15 - Effective dates of coverage for current employees

Current through Vol. 41, No. 20, July 1, 2024
An employee other than an education employee is eligible to
				  participate if not classified as seasonal or temporary and whose actual
				  performance of duties normally requires one thousand [1,000] hours per year or
				  more. An education employee who is a member of or eligible to participate in
				  the Oklahoma Teacher's Retirement System and working a minimum of four [4]
				  hours per day or twenty [20] hours per week may participate in the Plan.
				  Part-time education employees are those who meet the requirements of a
				  half-time employee as defined by the Oklahoma Teachers Retirement System.
				  Eligible employees shall be covered on the first
				  [1st] day of the month following the month in which
				  the employee is in an eligible status.
(1) If an employee is absent due to accident
				or illness on the date the employee coverage would normally become effective,
				benefits shall not be payable until the employee returns to the job. If the
				employee is absent from work because of a holiday, vacation or nonscheduled
				working day and the employee was on the job on a scheduled working day
				immediately preceding the effective date, this effective date will not be
				changed. An employee coming to work during the latter part of a payroll period
				who is not able to complete an insurance change form should be placed on the
				appropriate plans on the first [1st] day of the
				following month with employee only coverage, so that the employee life, dental
				and health will be in effect. Members may add optional coverages within the
				member's initial thirty [30] day enrollment period to be effective the first
				[1st] day of the month following the date the member
				enrolled for optional coverages.
(2) Participating entities shall forward
				members' enrollment information and any changes to enrollment information
				during the initial enrollment period to the Administrator within ten [10] days
				after the last day a member may enroll.
(3) If an employee leaves a participating
				entity and is hired by another participating entity within the following thirty
				[30] day period, premiums must be forwarded to EGID to avoid a break in
				coverage.
(4) An enrolled member
				who terminates employment or is in leave without pay status and whose spouse is
				also an enrolled employee may transfer coverage to their spouse to be insured
				as a dependent. The health, dental, vision and basic life may be transferred.
				The employee's basic life amount will transfer to a dependent spouse amount. If
				there are dependent children, they must also be insured unless they have other
				group or qualified individual health insurance.
(5) An employee that terminates from a
				participating employer and is hired by another participating employer shall be
				entitled to be treated as a new employee with new health, dental, vision and
				life benefit options available. A rehired employee returning to a former
				employer has new health, dental and vision benefit options only after a thirty
				[30] day break in coverage and may be subject to orthodontic
				limitations.
(6) Except as provided
				by statute, an individual employee may choose not to be enrolled in the health
				or dental plans or may disenroll from these plans because of other health or
				group dental coverage or by reason of eligibility for military or Indian health
				services within thirty [30] days after the date the employee becomes eligible
				for the other health or group dental coverage. Such employees who subsequently
				lose the other coverage or eligibility for military or Indian health services
				may enroll in the corresponding health or dental plans offered through EGID if
				the election is made no later than thirty [30] days after the date of loss of
				the other coverage. At the insured's option, in order to avoid a break in
				coverage and the application of the dental limitation, coverage under this Plan
				shall become effective on the first [1st] day of the
				month during which the insured actually lost the previous coverage, provided
				the insured pays the full premium for that month. Otherwise, coverage shall
				become effective under this Plan on the first [1st]
				day of the month following the election of health and/or dental coverage, and
				any break in coverage shall result in the application of the HealthChoice
				dental limitations. Excepted Benefits do not qualify as other health coverage
				for purposes of this rule.