Special Eligibility Situations
Subscribers can make changes to their coverage when a special eligibility situation occurs. Unless otherwise noted, all changes must be made within 31 days of the event.
If you, as a covered subscriber, wish to add a spouse because you marry, you can do so by completing an NOE and submitting a copy of your marriage license within 31 days of the date of your marriage. You may enroll yourself and your spouse (must provide spouse's social security number) and eligible children/stepchildren for your health, dental, vision and life insurance by submitting a completed Notice of Election form and proper documentation of dependent eligibility to your benefits office. You may also enroll in or increase your Optional Life by up to $50,000 and enroll in or change contributions to a Medical or Dependent Care Spending account.
A subscriber can enroll his spouse, without medical evidence, in $10,000 or $20,000 in Dependent Life-Spouse coverage within 31 days of the marriage. Subscribers can also enroll eligible dependent children in Dependent Life-Child coverage within 31 days of the marriage.
To enroll a dependent child, the employee must provide a copy of the child's long form birth certificate and provide the child's social security number.
Legal Separation & divorce
If you and your covered spouse separate, your spouse may remain on your health, Dental/Dental Plus, State Vision Plan and Dependent Life-Spouse coverage until the divorce is final. Once the divorce is final, the employee needs to either go to mybenefit.sc.gov and enter a change as "divorce" and upload the full divorce decree, this will change your status to divorced and note the spouse as a "former spouse" and remove the "former spouse" and stepchildren from your coverages as of the divorce date. If not processed in MyBenefits, make sure to contact Angelia Baker in Benefits within 31 days of your divorce date to make your status change and remove your former spouse/stepchildren from your coverage.
If you fail to drop your divorced spouse or former stepchildren within 31 days of the date the court order or divorce decree is stamped by the court, the change in coverage is effective the first of the month after your signature on the NOE dropping your former dependents.
Eligible children may be added by changes made in MyBenefits.sc.gov within 31 days of the qualifying event.
- Newborn: Effective on date of birth .
- Marriage of the subscriber to the child’s parent (effective on the date the marriage).
- Adoption or placement for adoption (effective on the date of adoption or placement for adoption).
- Placement of a foster child(effective on the date of placement)
- Loss of other coverage (effective on the date of loss of coverage).
APPEALS: If you are dissatisfied after an eligibility determination that has been made, you may ask PEBA Insurance Benefits to review the decision.
If you are an employee, a Request for Review should be submitted through your benefits office. You may write a letter to be sent with the Request for Review form. If the request for review is denied, you may appeal by writing to the PEBA Insurance Benefits Appeals Committee within 90 days of notice of the decision. If the PEBA Insurance Benefits Appeals Committee denies your appeal, you have 30 days to seek judicial review as provided by Sections 1-11-710 and 1-23-380 of the S.C. Code of Laws, as amended.