County of Summit employees working 30 or more hours per week are entitled to health benefits on their date of hire.

Newly hired benefit eligible employees will receive a benefit enrollment email with a link and password information to the benefit system, BenXpress. New hires must enroll or waive County of Summit health within 30 days of their benefit eligibility date. Please refer to the plan year Insurance Benefits menu tab for plan and rate information. Benefit coverage is retroactive to your hire date, and you will be responsible for paying premiums for the retroactive period.

If you are enrolling dependents (spouse or child) for the first time, you must upload the required dependent documentation during the enrollment process while making your benefit elections. If the required documentation is not submitted within the 30-day eligibility period, your dependent(s) will not be covered.

ELIGIBILITY AND REQUIRED DOCUMENTS

Employee/Spouse

• Copy of Marriage License (Legal Copy)
• Copy of Divorce Decree (if applicable)/Separation Agreement

Child

• Legible copy of birth certificate (not proof of birth letter) listing employees name
• Copy of adoption or guardianship papers listing employee and child (if applicable)

Step-Child

• Legible copy of birth certificate showing one or both parent’s name.
• ​Copy of a valid court order showing who is responsible for providing healthcare coverage with one or both parent’s name.

Please note: In addition to the birth certificate court order you must be able to prove the employee/step-child relationship (a valid birth certificate along with a valid marriage certificate listing both employee and spouse would prove the employee is tied to the step-child). Federal law allows eligible dependent married or unmarried children to be covered until they reach age 26. 

YOU MUST REPORT ALL CHANGES IN FAMILY STATUS TO THE DIVISION OF EMPLOYEE BENEFITS, insurance@summitoh.net  WTITHIN 30 DAYS OF THE EVENT. Failure to report changes in a timely manner may result in delay, denial of coverage, or the loss of the option to exercise COBRA continuation.

Once your Qualifying Life Event (QLE) documentation is emailed and reviewed by the Division of Employee Benefits, an event is created in the benefit system, and you will receive an email prompting you to complete the enrollment process in BenXpress. Benefit coverage is retroactive to the date of the event (e.g., date of birth, marriage, divorce), and you will be responsible for paying premiums for the retroactive period.

If you are enrolling dependents (spouse and/or child(ren)) for the first time, you must upload the required dependent documentation during the QLE enrollment process while making your benefit elections. If the dependent documentation is not submitted and approved within the 30-day eligibility period, your dependent(s) will not be covered.

QUALIFYING LIFE EVENTS

Marriage

• Addition of spouse and stepchildren. You must notify your Benefit Coordinator or email a copy of your marriage abstract/certificate (legal copy) to insurance@summitoh.net within 30 days of the event. If you plan to add a stepchild(ren) to your plan, you must also upload the required dependent documentation within 30 days of the event. Remember to review your beneficiaries!  

Divorce/Legal Separation

• Removal of spouse and stepchildren. You must notify your Benefit Coordinator or email a copy of the divorce/separation agreement to the Division of Employee Benefits, insurance@summitoh.net,  within 30 days when there is a change in martial or relationship status, such as, in the case of divorce, dissolution, or legal separation. Remember to review your beneficiaries!  

Birth/Adoption of a Child

• Addition of a child. You must notify your Benefit Coordinator or email the Division of Employee Benefits stating the date of birth to insurance@summitoh.net,  within 30 days of the birth or adoption of a child to ensure your dependent is added to your plan. Rember to review your beneficiaries!

Loss/Gain of Health Coverage

• Losing existing or gaining health coverage, including job-based, individual, student plans, eligibility for Medicare, Medicaid, and CHIP. You must notify your Benefit Coordinator or email the Division of Employee Benefits Department documentation stating the date of loss/gain of coverage to insurance@summitoh.net,  within 30 days of the gain/loss of coverage and submit documentation with the date of loss/gain of coverage.

10% Increase or Decrease in Salary

• When an employee experiences a salary increase or decrease of 10% or more, it is considered a QLE. The benefit system automatically generates an email notification to the employee, prompting employees to complete the event.

You or your Eligible Dependent who has declined the coverage offered by County of Summit may enroll for coverage under this plan during any special enrollment period if you lose coverage or add a dependent for the following reasons, as well as any other event that may be added by federal regulations:

• In order to qualify for special enrollment rights because of loss of coverage, you or your Eligible Dependent must have had other group health plan coverage at the time coverage under this plan was previously offered.
• If coverage was non-COBRA, loss of eligibility or the Group's contributions must end. A loss of eligibility for special enrollment includes:
  • Loss of eligibility for coverage as a result of divorce or legal separation
  • Cessation of dependent status (such as attaining the maximum age to be eligible as a dependent child under the plan)
  • Death of an Eligible Employee
  • Termination of employment
  • Reduction in the number of hours of employment that results in a loss of eligibility for plan participation (including a strike, layoff or lock-out)
  • Loss of coverage that was one of multiple health insurance plans offered by an employer, and the Eligible Employee elects a different plan during an open enrollment period
  • An individual no longer resides, lives, or works in an HMO Service Area (whether or not within the choice of the individual), and no other benefit package is available to the individual through the other employer
  • A situation in which a plan no longer offers any benefits to the class of similarly situated individuals that includes the individual
  • A situation in which an individual incurs a claim that would meet or exceed a medical plan lifetime limit on all benefits (additional requirements apply)
  • Termination of an employee's or dependent's coverage under Medicaid or under a state child health insurance plan (CHIP)
  • The employee or dependent is determined to be eligible for premium assistance in the Group's plan under a Medicaid or CHIP plan
• If you or your Eligible Dependent has COBRA coverage, the coverage must be exhausted in order to trigger a special enrollment right. Generally, this means the entire 18, 29 or 36-monthCOBRA period must be completed in order to trigger a special enrollment for loss of other coverage.

• Enrollment requires written documentation confirming the termination of any other health coverage, including the effective date of that termination. Notice of intent to enroll must be submitted to the carrier by the Group within thirty-one (31) days of the qualifying event, and coverage will begin on the date the prior coverage ended. For termination of Medicaid or CHIP coverage, or eligibility for premium assistance, notice of intent to enroll must be submitted within sixty (60) days of the qualifying event. Coverage will begin on the date of that event. If you acquire a new dependent through marriage, birth, adoption, or placement for adoption, you may enroll yourself and your Eligible Dependents, provided that the enrollment request is submitted within thirty (30) days of the event.

To request special enrollment or obtain more information, contact the Division of Employee Benefits at (330) 643-5551 or Insurance@summitoh.net.