LIFE HAPPENS

BIRTH OR ADOPTION OF A CHILD

A covered Freelance employee may qualify for short term disability payments during the period of unemployment due to the birth and immediate care of a newborn child. Please refer to the Met Life Disability documents for Pregnancy, Summary Descriptions and Claim forms relative to your state of residency by clicking HERE.

Following the birth, adoption, or placement for adoption of a child, you may enroll the child, as well an eligible spouse.

Other children may not enroll until open enrollment.

Pending the timely receipt of the enrollment form, coverage will be effective as of the date of birth.

Enrollment must be made within 31 days of the birth or date of adoption or placement for adoption, or the enrollment will be delayed until the next Open Enrollment for an effective date of January 1.

You may provide a copy of the hospital birth certificate while you wait for the certified copy.

If the participant is a freelance employee, check the Freelancers section of this site for details on the cost structure for dependent coverage.

If the participant is a staff employee, check with your employer for dependent coverage costs.

To add a child to your coverage, email enrollment@synergyenrollment.com or call Bryana at Synergy Enrollment at 858-282-0660 for assistance in enrollment and providing all documentation needed for coverage to commence.

A DEPENDENT CHILD TURNS 26

When a dependent child turns 26, the child is no longer eligible for dependent coverage.

When a dependent child turns 26, the child is eligible for COBRA continuation coverage for 36 months as long as the Participant notifies the plan within 60 days of the child’s 26th birthday.

COBRA allows you to continue the coverage by paying the monthly premiums yourself.

For the COBRA enrollment form, click HERE.

Note: The eligibility of a child under age 26 is not affected by marital status, financial dependency or school enrollment.

​MARRIAGE

You may enroll a new spouse within 31 days of the marriage.

Your new spouse’s children may also enroll at that time.

You must provide a copy of the Marriage Certificate.

Enrollment must be made within 31 days of the birth or date of adoption or placement for adoption, or the enrollment will be delayed until the next Open Enrollment for an effective date of January 1.

If the participant is a freelance employee, check the Freelancers section of this site for details on the cost structure for dependent coverage.

If the participant is a staff employee, check with your employer for dependent coverage costs.

To add a spouse or domestic partner, email enrollment@synergyenrollment or call Synergy Enrollment at 858-282-0660 for assistance in enrollment and providing all documentation needed for coverage to commence.

Coverage will commence on the first of the month following a 30 day processing period after the Plan’s receipt of the enrollment form.

You can download the enrollment form by clicking HERE.

DIVORCE

Your former spouse will remain eligible for coverage until the last day of the month in which your divorce is final or you obtain a legal separation.

To ensure your former spouse is eligible for COBRA continuation coverage for 36 months, you must provide a copy of your final divorce decree within 60 days of the date of the divorce. Be sure to include in the cover letter your former spouse’s name, address, phone number and email address.

Failure to notify the plan within 60 days of the divorce will cause your former spouse to lose his or her COBRA rights and may make you liable for any health claims paid by the Plan’s insurers for any services received after the expiration of the spouse’s eligibility.

You can disenroll a former spouse or domestic partner by calling Bryana at Synergy Enrollment at 858-282-0660 or by emailing enrollment@synergyenrollment.com.

You can download the form to enroll a former spouse in COBRA continuation coverage by clicking HERE.

FALLING SHORT OF THE ELIGIBILITY REQUIREMENTS? (Freelancers)

Once a Freelancer qualifies for coverage you will need to requalify each year to continue coverage by working 100 qualifying days, by combining worked days and banked days to equal at least 100 days, by earning 35,000 qualifying dollars, or by accumulating at least 50 combined worked and banked days and making Bridge Payments. Click HERE for more information about Banked days and Bridge Payments.

If you do not meet the eligibility requirements to continue coverage, you and your covered dependents may be eligible for COBRA Continuation Coverage. See below for details.

STAFF EMPLOYMENT IS ENDING?

If your covered employment is terminated without cause (i.e. you are laid off, the company closes, your position is eliminated, or other reasons that do not include your firing for cause), you and your covered dependents may be eligible for COBRA Continuation Coverage. See below for details.

COBRA CONTINUATION COVERAGE:

If your PHBP coverage is terminated because you are no longer eligible, you will be offered COBRA continuation coverage for yourself and any eligible covered dependents.

You may pay the cost of your insurance premium plus a small administrative fee and continue your and your dependents PHBP coverage for up to 18 months. Generally, the PHBP premiums are likely to be much less than a similar policy would cost on the individual market.

Click here to get more information about enrollment and current costs for COBRA continuation coverage.

CHANGING YOUR EMPLOYMENT FROM FREELANCE TO STAFF:

Freelance coverage continues through the end of the month in which a Freelancer becomes staff.

Staff coverage begins the first of the following month (the day after the last day of Freelance coverage).

All unused months of the Freelancer’s current annual coverage period can be ‘banked’ for up to 18 months and can be used immediately to reinstate coverage if the staff employment ends within the 18 month banking period.

CHANGING YOUR EMPLOYMENT FROM STAFF TO FREELANCE:

The former staff employee gets 2 days credit per month worked for a participating employer, for up to 36 total days credit (18 months of staff coverage).

The credited days will apply towards the 100 days needed to qualify for freelance coverage.

Standard Freelance eligibility rules apply. Click HEREto go to the Freelancer page for details about qualifying work.

Example: If a staff employee worked for 10 months at a participating employer, s/he would get 20 days credited towards the needed 100 days. The former staff employee would therefore need to either earn $35,000 or work (only) 80 days in the first year in order to qualify for freelance coverage.

CHANGING YOUR STAFF EMPLOYMENT FROM ONE PARTICIPATING EMPLOYER TO ANOTHER:

If a covered staff employee leaves the employ of one participating employer to work at a different participating employer, the transfer of coverage is immediate and without interruption.

Be sure to tell your new employer that you are currently covered by the PHBP with your current employer.

DEATH OF A PARTICIPANT

In the event of the death of a covered employee (Freelance or Staff) COBRA continuation coverage will be offered for 36 months to all Dependents covered by the Plan at the time of death.

COBRA continuation coverage must be elected within 60 days of the death of the participant.

A copy of the death certificate is to be provided to the Plan. Please call Synergy Enrollment at 858-282-0660 or email enrollment@synergyenrollment.com for detials.

Dependents of a deceased Freelance or Staff Employee should contact the Plan administrator at 855-696-2909 or staff@PHBPBenefits.org to notify them of their intention to elect COBRA continuation coverage. Please provide the name of the deceased employee, the date of death, and the names of all dependents in any correspondence.

SHORT TERM DISABILITY (Freelancers only)

In the event a covered Freelance employee is temporarily disabled and unable to perform your usual work, including pregnancy and the birth of a child, you may qualify for Short Term Disability (STD) payments to cover 60% of your pre-disability weekly income up to $3,000 per week.

Please refer to the Summary Descriptions, Claim forms, and information on Pregnancy claims relative to your State of residence by clicking HERE.

LONG TERM DISABILITY (Freelancers only)

In the event a covered Freelance employee is partially or totally disabled and unable to perform your usual work, you may qualify for Long Term Disability (LTD) payments to cover 60% of your monthly income up to $12,500 per month.

Please refer to Summary Descriptions and Claim forms relative to your state of residency by clicking HERE.

DEPENDENT CHILD DISABILITY

A child age 26 or older of a covered Staff or Freelance employee who is unable to support themselves due to physical handicap, mental illness, developmental disability, or mental retardation as defined by applicable law, the child is eligible for coverage.

The incapacity must have started before the child reached age 26, must be certified by a doctor, and will require annual recertification.

Written proof of the child’s disability must be submitted within 31 days after the coverage would have otherwise ended.

TRAVELING ABROAD OR OUT OF TOWN:

Check the Anthem website for local in-network providers in the town in which your traveling if you anticipate the need for medical care.

Emergency medical services overseas are reimbursed according to the carrier’s “reasonable expense”. Be sure to keep all receipts with as many details as possible.

No work injury, whether domestic or abroad, is covered by the PHBP. Check with your employer about their workers compensation policy for work performed abroad.

To learn more about coverage while traveling domestically or abroad, click HERE.