Frequently asked questions

Eligibility

All regular, full-time employees (working 30 hours or more a week) are eligible to enroll in The Sample Company’s group benefits plans.
You can enroll your “eligible” dependents for medical, dental, and vision coverage effective first of the month following your date of hire or should there be a qualifying event throughout the year.
Eligible dependents include:
  • Your legally married same or opposite sex spouse.
  • Your domestic partner.
  • Your children, adopted children, or domestic partner’s children through age 26 (coverage ends at the end of the month in which the dependent turns 26 for the medical, dental and vision plans).
  • Children for whom the Plan is required to provide coverage under the Qualified Medical Child Support Order (QMCSO).
  • Your mentally challenged or developmentally disabled adult children who live with you and who are primarily dependent on your support (you must provide documentation), provided that the child was disabled prior to age 26. Any adult child of your domestic partner who satisfies this definition will also be eligible.
  • Domestic Partners are not currently recognized by the IRS as dependents. Therefore, the portion of premiums your employer pays on behalf of your Domestic Partners must be taxed. This process is called “imputed income.” The imputed income resulting from Domestic Partner (and children of a Domestic Partner) coverage is deemed to be W2 wages. Applicable taxes will be withheld on the Domestic Partners benefits and all employee contributions must be made on a post-tax basis.
COBRA coverage gives employees and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time. Examples of circumstances that would allow a member to elect COBRA: voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. Individuals that elect COBRA coverage are responsible for the entire premium. The duration of COBRA coverage is dependent upon the COBRA qualifying event.
You do not have to elect Medicare or Medicaid when you become eligible. Generally, if you are covered on an employer plan plus Medicare or Medicaid, your employer plan will pay first.

Changes to Your Benefits

In general, you can only select and change your benefits during Open Enrollment. Open Enrollment usually takes place between the end of October and the end of November each year with your benefits effective January 1st. IRS Section 125 prohibits you from changing your enrollment during the plan year unless you experience a Qualifying Life Event.
  • Your marriage, legal separation, or divorce.
  • The birth or adoption of a child.
  • The loss of coverage eligibility for a dependent child.
  • The loss of coverage under your spouse’s or other employer’s plan.
  • The death of a spouse or dependent child.

Medical/Rx

Some examples of preventative care are annual physicals, well-women exams, child immunizations, mammograms (over a certain age), colonoscopies (over a certain age), and more.
  1. Visit www.anthem.com
  2. Click “Find a Doctor”
    • If you are already registered, you will be prompted to login.
    • If you are not registered, you will need to continue as a guest by selecting Plan from an employer.
  3. Input your search radius and click continue
  4. Select the network for your plan: BlueCard National PPO

Dental

Services that keep your teeth and gums healthy are considered preventative. A few examples are routine exams, teeth cleanings, and more. For a more detailed list, view the Guardian benefit summary in the document library.
Click this link to learn more about how the maximum rollover benefit works: https://www.guardianlife.com/dental-insurance/rollover
Visit this website to learn more about the Guardian college tuition benefit program: https://guardian.collegetuitionbenefit.com/
  1. Visit https://www.guardiananytime.com/fpapp/FPWeb/search
  2. Choose your type of dental plan – PPO or DHMO
  3. Enter additional criteria and click “search.”

Vision

  1. Visit https://www.guardiananytime.com/fpapp/FPWeb/vision
  2. Choose your vision network
  3. Enter additional criteria and click “search.”

Life and AD&D

Evidence of insurability (EOI) is a record of a person’s past and current health events. It’s used by insurance companies to verify whether a person meets the definition of good health in order to receive coverage – most commonly for life insurance. You will be required to submit evidence of insurability if you have applied for a life insurance amount in excess of the guaranteed issue level.
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