Open Enrollment FAQs
Open Enrollment FAQs
Q: Who can I add onto my Medical Insurance?
Eligible dependents are as follows: spouse, same gender life partners, and children under the age of 26. Please review the “General Documents Required” page on our website for more information.
Q: Do I have to complete a letter of attestation every year?
At this time you are not required to submit a letter of attestation if your spouse’s eligibility for employer healthcare has remained the same. An attestation is required for any enrollment change requests such as adding a newborn or enrolling a spouse for the first time. You are obligated to contact the Benefits Office, firstname.lastname@example.org within 30 days, if your spouse’s eligibility were to change.
Q: How do I add my spouse and/or child(ren) to my coverage during Open Enrollment?
Complete the Health Application and Attestation that is available on our website and submit it with supporting documentation, such as a Marriage Certificate or a Birth Certificate. This can be sent to email@example.com or by fax to 215-400-4631 Please review the “General Documents Required” page on our website for more information.
Q: Will my dependent(s) be removed if I do nothing during Open Enrollment?
No. Dependent(s) will only be removed to age (children up to aged 26) or at the request of the employee.
Q: I am getting married and/or having a child after the May Open Enrollment period. Can I enroll them now?
No; however, there is a special enrollment period when you can add dependents to your coverage throughout the year. Once you experience a qualifying event, such as a marriage or birth of child, you may enroll your dependent within 30 days of such event.
* For example, you are getting married on July 21, 2017. You have 30 days to add your spouse to your coverage. If you do not add your spouse within the 30 days, you will have to wait until Open Enrollment of the following year. The same policy applies to adding a child due to adoption, gain of custody, or birth.
Q: When am I eligible to switch to Personal Choice?
Members of PFT and SPAP may change from Keystone Health Plan East HMO coverage to Personal Choice PPO after four years of full-time service is completed. For example, if you were hired in September 1, 2009, four years of service was completed on September 1, 2013.
CASA members may select the Personal Choice 20/30/70% plan during the Open Enrollment period following their first year of CASA service.
Non-Represented employees can elect Personal Choice at the time of hire or during the annual Open Enrollment period.
Q: How do I change from Keystone to Personal Choice?
Complete the Health Application and Attestation. Completed forms can be sent to firstname.lastname@example.org or by fax to 215-400-4631 or during walk in customer service hours (Monday through Thursday 9:00 AM to 5:00 PM).
Q: How much do I have to pay if I change to the Personal Choice PPO coverage?
Premiums are based on your position and coverage tier
- PFT and SPAP employees who have four years of full time service are eligible to switch from Keystone Health Plan East to Personal Choice. PFT and SPAP employees enrolled before August 31, 2014 are required to pay a 3% premium co-share for Personal Choice. This is in addition to 1.25% of gross salary for medical coverage and spousal/life partner surcharge if applicable. PFT employees enrolled after September 1, 2014 are required to pay a 5% premium co-share.There is no premium co-share for Keystone HMO.
- Employees represented by CASA and enrolled in Personal Choice 20/30/70 are required to pay a 8% base PC320 premium co-share plus a “buy-up”.
- Non-Represented employees enrolled in Personal Choice 20/30/70 before June 30, 2014 are required to pay a 5% premium co-share. Non-Represented employees enrolling with an effective date of 7/1/2014 or later must pay the 8% base PC 320 premium plus a “buy-up”. Employees enrolled in Keystone have a 5% premium co-share for Keystone HMO. Premiums are deducted on a pre-tax basis every pay.
- Per pay costs are listed here.
Q: Can I make changes to my dental, vision and prescription coverage?
CASA, SPAP and Non-Represented employees may make changes to their Dental, Vision and Prescription coverage during the Open Enrollment period. PFT, District 1201/32 BJ and Local 634 employees must contact their unions to make changes to these plans.
Q: I have medical insurance outside of the School District of Philadelphia. Can I opt-out and get paid?
Only Local 634 members can opt-out of the insurance in exchange for a monthly reimbursement. Employees must complete the Universal Opt Out Application along with a Certificate of Group Coverage which provides proof of alternate insurance. You can opt-out of the insurance any time of the year; the application deadline is on the 16th of each month.
All other employees are eligible to waive health coverage, but cannot receive compensation to opt-out.
Q: What is the spousal surcharge?
For Non-Represented Employees:
You may be subject to a $40 per pay additional charge for your medical benefits if your spouse/life partner is eligible for medical coverage through his/her employer, regardless of his/her enrollment status.
For CASA represented employees:
You may be subject to a $75 per pay additional charge for your medical benefits if your spouse/life partner is eligible for medical coverage through his/her employer, regardless of his/her enrollment status.
For PFT and SPAP represented Employees:
You may be subject to a $50 per month additional charge for your medical benefits if your spouse/life partner is eligible for medical coverage through his/her employer, regardless of his/her enrollment status. This will increase to $75 per month beginning September 1, 2019.
Q: Who has to pay the spousal surcharge?
PFT, SPAP, CASA and Non Represented employees are subject to the spousal surcharge if they cover a spouse/life partner on SDP benefits who is offered coverage by his or her employer.
Q: What do I need to do if I believe I am not subject to the spousal surcharge?
If your spouse/life partner works for an employer other than the School District of Philadelphia, you are eligible to waive the surcharge if they are not entitled to medical coverage through his/her employment. You must complete and submit an Health Application and Attestation during the Open Enrollment period or within 30 days of a qualifying event.
Q: My spouse is retired and eligible for Medicare. Am I subject to the spousal surcharge?
You are only subject to the spousal surcharge if your spouse/life partner is eligible for coverage on account of their current, active employment.
Q: When can I apply for Wage Continuation coverage?
All employees can apply for Wage Continuation coverage during the annual Open Enrollment period or at time of hire.
Q: When can I cancel my Wage Continuation coverage?
PFT, SPAP, Non represented, CASA, Local 634, and 1201/32 BJ members can only cancel coverage during Open Enrollment.
No action is required if you do not wish to make any changes.
Q: Where can I send my Wage Continuation form?
Enrollment application and cancellation forms can be sent to email@example.com or by fax to 215-400-4631 or in person Monday through Friday from 9-5 in Suite G-10. If faxing, please call 215-400-4630 to confirm receipt.
If you are faxing or mailing paperwork, you must call 215-400-4631 or email firstname.lastname@example.org to confirm receipt. We are not responsible for forms that were not faxed properly or are illegible. Employees requesting an Open Enrollment request should keep a copy of the request along with proof of submission.
You may visit our office during walk-in customer service hours, Monday – Friday 9 A.M. to 5 P.M.
Changes made during Open Enrollment will take effect July 1. Requests received after the Open Enrollment period will not be processed.
Benefit changes as a result of a qualifying life event will be accepted during the year; however, these must be received by the Benefits Office within 30 days of the qualifying event date. Examples of life events are birth of a child, marriage, divorce, adoption, loss/gain of other health insurance, etc.
If negotiations result in a material change to your benefits eligibility or premiums, we will communicate your options at that time.