Enrollment and Eligibility
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 complete the online enrollment process within 31 calendar days after your hire date by logging into shp.benelogic.com. Refer to the New Hire Enrollment Guide provided by your Employer.
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 the insurance benefits you are required to complete a waiver online. The start date of your benefits depends on your contract with your employer.
Proof Of Eligibility Requirements
In order to be eligible for coverage under the SHP Medical Plan, any spouse of an eligible employee who has coverage available through an employer-sponsored group health plan must join that plan on at least a single enrollment basis, provided the spouse’s contribution level is 50% or less.
If you enroll your spouse as a dependent, you must also complete the Spousal Employer Verification Form and return to the plan’s Administrative Support Team (AST) at AST@planmanagementservice.com so they can coordinate benefits with your spouse’s employer-sponsored group health plan.
Dependent Children’s Enrollment
Mid-Year Changes: When family status changes occur, the last thing on your mind is to update your employer of these changes. However, failure to notify your employer may cause your medical claim payments to be delayed or denied. Also, your rights to enroll in the plan or continue coverage may expire. Notify your Human Resources on the enrollment/change form of the following changes within 31 days of the qualifying event if loss of medical coverage due to:
- Spouse’s coverage ends with employer due to termination or reduction of hours
- COBRA exhausted
- Qualified Medical Child Support Order
- Child turns 26 on medical or dental plan
- Child gets married
- Address or phone number change
Eligible children include those up to age 26 for the Medical and Dental plans. For disabled children over the age of 26, the “Disabled Dependent – Certification of Disability form” will been to be completed. Updated Disabled Dependent forms will be required again every 5 years.
Special provision: Newborns are covered at the moment of birth ONLY if you enroll your new baby in the plan within 60 days immediately following birth.
Your medical claim payments may be delayed or denied if you do not notify your Employer Human Resources or Business Office.
When Coverage Can Be Added Or Terminated
In general you cannot change or drop your health benefits unless it is done during the plan’s annual Open Enrollment, or you experience a qualifying event and make the change within 31 days of the event.
Open Enrollment Period:
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. You must participate in open enrollment to enroll or make a change. 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 Brochure provided by your Employer to guide you through your online enrollment. Login to the Employee portal at shp.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