PEBP offers employees the choice of a PPO medical plan or an HMO plan. Both plans include medical, pharmacy, dental, vision, life, accidental death and dismemberment, group travel accident and long-term disability insurance. In addition, there are several voluntary products available to active employees.

This page includes a summary of various topics for quick viewing. For more detailed information click here.

Summary of topics on this page:

• Eligibility Requirements

• Employee Benefits Orientation

• Supporting Eligibility Documentation

• Qualifying Status Changes

• Declining Employee Coverage

• Voluntary Products

Eligibility Requirements

Newly hired employees must work full-time (minimum of 80 hours per month for 3 months to be eligible for coverage). Coverage begins on the 1st day of the month following 3 months of full-time employment.

If employment is reinstated within one year of the termination date, the employee is classified as a reinstatement. The 3 month waiting period is waived and coverage is effective on the first day of the month concurrent with or following the hire date.

An employee who is rehired 12 months or more after their termination date, or who is rehired within 12 months but moves from a non-state to a state agency. Coverage begins the first of the month following 3 months of full-time employment.

Supporting Eligibility Documentation

To begin coverage, a Benefit Enrollment and Change Form (BECF) must be submitted along with supporting eligibility documents to the employees’ agency representative. Supporting documents are required to verify eligibility for any newly enrolling dependent. Examples of supporting documentation include copies of certified marriage certificates, certified birth certificates and full-time student verification (if child is age 19 through 23).

Qualifying Status Change

Once an employee is enrolled in the plan, coverage remains the same for the entire plan year (July 1st through June 30th), unless the employee experiences a qualifying status change.

Declining Employee Coverage

A newly hired or rehired employee may decline (opt-out-of) coverage offered during their new hire enrollment period. Employees who decline coverage lose the following benefits: medical, dental, pharmacy, vision, life, accidental death and dismemberment, group travel accident and long-term disability coverage.

Voluntary benefits:  A brief description of the voluntary benefits appears below.  For more information about voluntary benefits, visit the applicable vendor’s website here. 

Long Term Care (LTC), provided by UNUM Provident

Long Term Care is the assistance received when someone needs help with two or more Activities of Daily Living—such as dressing, bathing, going to the bathroom, eating or moving about—or when someone suffers a severe cognitive impairment.  This care could be provided in the home, in an assisted living or residential care facility, or in a skilled nursing facility such as a nursing home.  You can apply for coverage at any time by completing a medical questionnaire.  Benefits may be subject to a pre-existing condition exclusion.  Long Term Care insurance provides you with a choice of how and where you will receive care.

 Short Term Disability Insurance, provided by The Standard

Short Term Disability replaces a portion of your income if you become unable to work because of a covered sickness or a covered accident.  Short Term Disability provides 60% of your weekly pre-disability earnings, reduced by deductible income.  You have a choice of three Benefit Waiting Periods, meaning your disability income can be paid after 7 days, 14 days, or 30 days.  A Standard representative can assist you in determining the amount of your premium if you are interested in pursuing this option.

 Voluntary Life Insurance, provided by The Standard

PEBP enrolled employees receive $20,000 basic life insurance coverage to help protect loved ones in the event of the employee’s death.  Employees may also purchase additional Voluntary Life Insurance and have the premiums deducted directly from the second paycheck of each month.  New hires enrolled in PEBP can take advantage of a $100,000 guarantee issue period within the first 60 days of their medical plan effective date.  What this means is that the employee would not be required to provide evidence of insurability (answer medical questions) to purchase $100, 000 of life insurance coverage. Beyond the initial 60 day guarantee issue period, employees can still purchase additional coverage by providing evidence of insurability. 

Voluntary Accidental Death and Dismemberment (AD&D), provided by The Standard  

The amount of the AD&D insurance benefit for loss of life is equal to the amount payable for Voluntary Life insurance coverage on the date of the accident.  The amount of the AD&D insurance benefit for other covered losses is a percentage of the amount payable for Voluntary Life insurance on the date of the accident.   

Flexible Spending Account (FSA) provided by ASI

This plan allows you to set aside as much as $6,000 per plan year, tax free, on eligible medical expenses that are not covered by your medical plan, e.g., deductibles, copays, and co-insurance.   

This plan is also available for dependent child care, up to $5,000 per plan year, also tax free.  The amount you elect at the time of enrollment is deducted from the second paycheck of the month and deposited into your Flexible Spending Account.  It costs $3.50/month to participate and you may opt to receive a prescription and medical debit card for an additional $1.50/month.  Submit eligible incurred expenses to ASI for reimbursement. (New hire employee paid through Central Payroll, LCB, NDOT, PERS and State Boards and Commission can enroll in FSA within 60 days of their initial medical plan effective date.  Beyond the initial 60 day enrollment period, employees have the option to enroll in FSA during Open Enrollment.