DOUGLAS COUNTY INSURANCE ELIGIBILITY/OPTIONS

IMPORTANT INFORMATION REGARDING INSURANCE ELIGIBILITY

Please read carefully!!! 

EMPLOYEES

You are eligible to enroll under the Plan if you work at least 40 hours a week on a regular basis as a full-time employee or at least 20 hours a week on a regular basis as a part-time employee for the employer providing this coverage and you have satisfied any required waiting period.  (1^st of the month following 90 days.  Employees hired between the 1^st and the 7^th of the month are treated as if hired on the 1^st of the month).  You are eligible to remain enrolled if you are on an approved leave of absence under the Family and Medical Leave Act of 1993. 

DEPENDENTS 

If you are married, your legal spouse is eligible for insurance.  Your domestic partner, of the same gender, is eligible for coverage if he or she meets the eligibility criteria on the Domestic Partner Affidavit provided by your employer.  Your unmarried dependent children are eligible until their 19^th birthday.  A child is also eligible until his or her 23^rd birthday, if enrolled as a full-time student at an accredited college, university or vocational school or if a court or administrative order requires you to provide health insurance. 

For purposes of determining eligibility, the following are considered “children”: 

• Your natural child;
• Your spouse’s or domestic partner’s child, or adopted child;
• Children placed for adoption with you;
• Children of your domestic partner;
• A newborn child of a covered dependent for the first 31 days of the newborn’s life, but only if you are financially responsible for both the newborn and the covered dependent; and
• Children related to you by blood or marriage for whom you are the legal guardian.  You will need to provide a court order showing legal guardianship.

If you have a child who has sustained a disability rendering him/her physically or mentally incapable of self-support, that child may be eligible for insurance even though he or she is over 19 years old.  To be eligible, the child must be unmarried and principally dependent upon you for support.  The incapacity must have arisen before the 19^th birthday. You must provide us with a written physician’s statement that confirms that these conditions existed continuously prior to the child’s 19^th birthday.  Documentation of the child’s medical condition must be reviewed and approved by the ODS medical consultant.  Periodic review by the medical consultant will also be required on an ongoing basis. 

Dependents on active military status are not eligible. 

Qualified Medical Child Support Order (QMCSO) 

This plan will cover individuals deemed to be alternative recipients under a qualified medical child support order (QMCSO).  A QMCSO is a court judgment, decree, or order, or a state administrative order that has the force and effect of law, that is typically issued as part of a divorce or as part of a state child support order proceeding, and that requires health plan coverage for an alternative recipient.  An alternative recipient is a child of a participant who is recognized under a medical child support order as having a right to enrollment under a group health plan with respect to such participant. 

The effective date of coverage for a child added to the plan under a QMCSO is the date specified in the court order, or if none, the date of the court order. 

The Plan has detailed procedures for determining whether an order qualifies as a QMCSO.  You may obtain a copy of such procedures from the Plan Administrator without charge. 

NEW DEPENDENTS 

If you marry while you are insured under this Plan, your spouse and his or her children are eligible to enroll as of the date of the marriage.  A complete and signed application must be submitted within 60 days of the date of the marriage.  All dependents must meet eligibility requirements. 

Your domestic partner is eligible if he or she meets the criteria on the Affidavit of Domestic Partnership supplied by your employer.  The domestic partner and his or her dependents are eligible to enroll within 60 days of when you and your partner have signed the Affidavit.  A complete and signed application must be submitted within 60 days of the date on the Affidavit. 

Your newborn child or your covered dependent’s newborn child will automatically be insured for 31 days after birth.  To continue insurance, the insured employee must submit a complete and signed application within 60 days listing the new child as a dependent.  If we do not receive the application, insurance for the child will end 31 days following the birth.  Proof of legal guardianship will be required for coverage of a grandchild beyond the first 31 days from birth. 

Your covered dependent’s newborn child will automatically be insured for 31 days after he or she is born.  Coverage will end after 31 days unless you are designated by a court as legal custodian and/or guardian, with the expectation that the child will live in your household for at least one year. 

Adopted children are automatically insured for the first 31 days from the date of the adoption decree.  If a child is placed with you pending the completion of adoption proceedings, that child will be insured for the first 31 days from the date of placement.  To extend insurance beyond the first 31 days, the insured employee must submit a complete and signed application within 60 days listing the child as a dependent. 

Placement for adoption means you have assumed and retained a legal obligation for full or partial support of the child in anticipation of adoption. 

Renewal 

Your Employee Benefits Committee has recommended and the Board of Commissioners has approved renewing medical and dental insurance coverage with our current provider-Oregon Dental Service.  To minimize rate increases, only one of the previously offered plans will be available for 2007 – the Prime High Plan (N077).  The alternative to this plan will be a new Health Reimbursement Account opportunity with a high deductible insurance plan.  The details of both offerings are attached as a side-by-side comparison.  The good news for the 400+ employees already electing the Prime High Plan is the rate only increased 2.71% ($12.88 per pay period).  The HRA insurance plan option is actually a 19.37% decrease in monthly premium but will require you to meet deductibles.  The HRA plan differs from a traditional plan in that it will allow you to select your own physician and have more flexibility with alternative health care options. Please read the attached detailed information for more information on this new account plan.  

Dental Insurance 

The following table shows the current and projected employee monthly out of pocket health insurance premium costs, with ODS as the dental carrier. The monthly cap will remain at $999.41 per employee effective January 1, 2007 for employees electing the High Prime plan. Employees with employee only covering selecting the HRA will receive $75 per month credited to their individual HRA account and employees with dependents will receive $150 per month credited to their account due to the difference in deductibles. 

 *OOP – Out of Pocket: A predetermined amount of money that an individual must pay for their health insurance plan coverage.

Voluntary options available to employees include:

Flex Spending Account:  Employees have the option to participate in a Flexible Spending Account (Section 125) administered by Benefit Help Solutions which offers the ability to use pre-tax dollars to pay for eligible health and dependent care related expenses.  More information on this is found elsewhere in this packet.  If you choose not to participate at this time, please complete and return the enclosed waiver.  This does not preclude your participation in future calendar years.

BI-WEEKLY INSURANCE RATES TABLE
MONTHLY INSURANCE RATES TABLE

PLAN YEAR 2007 BI -WEEKLY INSURANCE RATES TABLE
JANUARY 1, 2007 THRU DECEMBER 31, 2007