Eligibility Changes. Employees who become eligible for a full Employer Contribution must make their benefit elections within thirty (30) calendar days of becoming eligible. If employees do not choose a health plan administrator and a primary care clinic and do not waive coverage within this thirty (30) day timeframe, they will be enrolled in a Benefit Level Two clinic (or Level One, if available) that meets established access standards in the health plan with the largest number of Benefit Level One and Two clinics in the county of the employee’s residence at the beginning of the insurance year. If employees who become eligible for a partial Employer Contribution choose to enroll in insurance, they must do so within thirty (30) days of becoming eligible or during open enrollment. An employee may change their health or dental plan if the employee changes to a new permanent work or residence location and the employee's current plan is no longer available. If the employee has family coverage and if the new residence location is outside of the current plan’s service area, the employee shall be permitted to switch to a new plan administrator and new Benefit Level within thirty (30) days of the residence location change. The election change must be due to and correspond with the change in status. An employee who receives notification of a work location change between the end of an open enrollment period and the beginning of the next insurance year, may change their health or dental plan within thirty (30) days of the date of the relocation under the same provisions accorded during the last open enrollment period. An employee or retiree may also change health or dental plans in any other situation in which the Employer is required by the applicable federal or state law to allow a plan change.
Eligibility Changes. Faculty members who become eligible for a full Employer 8 contribution must make their benefit elections within thirty (30) calendar days of 9 becoming eligible. If faculty members do not choose a health plan administrator and a 10 primary care clinic within this thirty (30) day timeframe, they will be enrolled in a 11 Benefit Level Two clinic (or Level One, if available) that meets established access 12 standards in the health plan with the largest number of Benefit Level One and Two 13 clinics in the county of the faculty member’s residence at the beginning of the insurance
Eligibility Changes. A faculty member who becomes eligible for a full Employer contribution must make the faculty member’s benefit elections within thirty (30) calendar days of becoming eligible. If a faculty member does not choose a health plan administrator and a primary care clinic within this thirty (30) day timeframe, the faculty member will be
Eligibility Changes. PBM shall load and make operable all Eligibility Changes electronically submitted by NDPERS in appropriate format no later than one (1) business day from receipt of such data. Eligibility information will be loaded in the order received. In the event PBM receives electronic Eligibility Changes that it cannot process for any reason, PBM will be responsible for notifying NDPERS within one (1) business day that the information that was transmitted cannot be processed. PBM shall also identify with specificity the deficiency in the eligibility information that prevents processing. Benefit Plan Changes. PBM shall electronically load all Benefit Plan Changes submitted by NDPERS into PBM’s systems no later than ten (10) business days after receiving said information, unless a different time period is mutually agreed upon in writing by the Parties. The electronic loading of all Benefit Plan Changes shall enable NDPERS to view the changes on-line through the portal. In the event PBM receives electronic submitted Benefit Plan changes that it cannot process for any reason, PBM will be responsible for notifying within twenty-four (24) hours of PBM’s receipt of the data that the Benefit Plan information transmitted cannot be processed. PBM shall also identify with specificity the deficiency in the Benefit Plan information that prevents processing. Standardized Edits. PBM shall be responsible for maintaining standardized “edits” to enable the necessary dispensing of Covered Items on behalf of NDPERS. Standardized “edits” shall include the following: Vacation overrides, lost/stolen/spilled overrides, emergency overrides, and school supply and facility overrides, in accordance with NDPERS’ directions. Clinical Services. The following Clinical services will be provided by PBM: Concurrent and Retrospective Drug Utilization Reviews. PBM shall provide concurrent and retrospective drug utilization evaluation on all Claims based on an agreed-upon PBM/NDPERS policy.
Eligibility Changes. Employees shall have the right to inform the City of an increase in their dependents at any time and have the amount contributed be adjusted accordingly, in accordance with PERS or the insurance carrier's rules. Employees shall inform the City within thirty days that one or more family members are no longer dependents, and the City shall correspondingly reduce its monthly contribution. Applicable circumstances include but are not limited to divorce, death, children turning 26 years old and a dependent obtaining other medical insurance.