County of Summit employees working 30 or more hours per week are entitled to health benefits on their date of hire. All new employees are required to enroll or waive County of Summit health benefits using the online self-enrollment system within 30 days of their benefit eligibility date. Eligibility verification and documentation are required for new enrollees and must be submitted to Insurance@summitoh.net within 30 days of your benefit eligibility date to your benefit coordinator. Please refer to the Benefit Eligibility and Documentation Requirements section for detailed information on eligibility and required documentation. If the required documentation is not submitted, dependents will be terminated until the next open enrollment period, and correct documentation is received. New Employee Benefit booklets are listed below for your specific agency.

Please download the forms in Adobe Acrobat, if you have the capability to do so. For better interactive form experience use Internet Explorer.

YOU MUST REPORT ALL CHANGES IN FAMILY STATUS TO THE DIVISION OF EMPLOYEE BENEFITS WTITHIN 30 DAYS OF THE OCCURRENCE. 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. IF ELIGIBLE EMPLOYEES, SPOUSES AND DEPENDENTS ARE NOT ENROLLED ON THE BENEFIT PLAN WITHIN 30 DAYS OF THEIR ELIGIBILITY DATE, ENROLLMENT WILL BE DEFERRED TO THE NEXT OPEN ENROLLMENT PERIOD.

QUALIFYING EVENTS

Marriage

• Addition of Spouse. The Division of Employee Benefits Department must be notified within 30 days of an employee marriage in order for the spouse to be enrolled on the County plan. Remember to update beneficiaries at this time if you choose.

Divorce/Legal Separation

• Employees must notify their Benefit Coordinator or the Division of Employee Benefits Department within 30 days when there is a change in martial or relationship status, such as, in the case of divorce, dissolution, or legal separation so that COBRA can be offered within 60 days. Remember to update beneficiaries at this time if you choose.

Birth/Adoption of a Child

• The addition of a dependent. Employees must notify the Division of Employee Benefits Department within 30 days of the birth or adoption of a child in order for coverage to begin on the event date.

Birthday/Dependent Age Limit

• Check your plan to see if your dependent children are eligible beyond age 26. If your dependent no longer meets the eligibility criteria, employees must notify the Division of Employee Benefits Department immediately so that COBRA can be offered within 60 days of their 26th birthdate.

Loss/Gain of Health Coverage

• Losing exisitng or gaining health coverage, including job-based, individual, student plans, eligibility for Medicare, Medicaid and CHIP. Employees must notify the Division of Employee Benefits Department within 30 days of the loss/gain.

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.

Please note: In addition to the birth certificate 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).

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

In addition to the court order you must be able to prove the employee/step-child relationship (a valid court order 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. 

Change of Address

• Notify your Benefit Coordinator anytime there is a change of address.

Waiving Health Benefits

A health incentive payment is available to employees waiving health benefits through the County of Summit. Employees waiving health benefits must provide proof of other health coverage to the Division of Employee Benefits at Insurance@summitoh.net within 30 days of date of hire or qualifying event date to receive the health incentive payment. Employees covered under a County of Summit health plan, as a spouse or dependent, are not eligible for the health incentive payment.

SPECIAL ENROLLMENT RIGHTS

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:

• 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 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-month COBRA period must be completed in order to trigger a special enrollment for loss of other coverage.
  • If coverage was non-COBRA, loss of eligibility or the Group's contributions must end. A loss of eligibility for special enrollment includes:
  • 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

• Enrollment must be supported by written documentation of the termination of the other coverage with the effective date of said termination stated therein. With the exception of items "j" (termination of Medicaid or CHIP coverage) and "k" (eligibility for premium assistance) above, notice of intent to enroll must be provided to Medical Mutual by the Group no later than thirty-one (31) days following the triggering event with coverage to become effective on the date the other coverage terminated. For items "j" and "k" above, notice of intent to enroll must be provided to Medical Mutual by the Group within sixty (60) days following the triggering event, with coverage to become effective on the date of the qualifying event. If you have a new dependent because of marriage, birth, adoption or placement for adoption, you may be able to enroll yourself and your Eligible Dependents provided that you request enrollment within thirty (30) days after the marriage, birth, adoption or placement for adoption.

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