​Medical and Dental Enrollment Application - New Enrollee or Transfer

Purpose: This action allows eligible employees to enroll in medical/dental insurance, decline medical/dental insurance, or add coverage for qualified dependents. 

       

Filling out the application:

To apply for Medical/Dental insurance, you must be eligible for medical benefits. If you are not eligible, the following error message will be displayed when attempting to access the Medical/Dental Enrollment application, "You are not eligible for medical insurance, please contact Office of Group Insurance".

  • Employees at Boise State University, Idaho State University, and the University of Idaho will not have access to Employee Self-Service.
  • Eligible employees can enroll in or decline medical plan coverage for themselves or dependents during the first 30 days of hire or with a qualifying life event.
  • If coverage has previously been declined then employees must wait until the Open Enrollment period or select a valid Change Request.​
  • Effective dates for coverage changes are based on application submission dates.
  • Eligible employees can decline dependent dental coverage at any time.
  • If an eligible employee has previously declined dependent dental coverage, the employee may add dependent dental when they have a qualifying event of marriage, birth or adoption.
  • When the open enrollment period ends, all Medical and Dental Enrollment applications with a 'Draft' status will be automatically deleted.  

Section 1: Application Information (Employee)

This portion of your application is prepopulated with some information from your personnel record.

  • Marital Status is a required field. If the Marital Status of 'Married' is selected, the 'Date of Marriage' is required.
  • Email Address is a required field. You must input a valid email address.

       

Section 2: Medical and Dental Benefit Selection

Part A - Complete Only to Decline All Benefits

If you choose to Decline All Benefits:

  • Select a valid Change Request, 'Decline ALL Medical and Dental' and 'SUBMIT' from the top banner. You will be re-directed to the Statement of Understanding where you must choose 'I Accept' or 'I Do Not Accept'.

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Part B - Premium-Only Plan Election

If you want to participate in the benefit program, continue selecting your options from the choices below:

  • Pre-Tax - With the Premium-Only Plan (POP), you can elect to have your medical/dental premiums deducted on a pre-tax basis (before federal, state, or Social Security/Medicare taxes are withheld). This reduces your taxable gross wages. After initial enrollment, you may change your POP election only during the annual open enrollment period.
  • Post Tax - With the Premium-Only Plan (POP), you can elect to have your medical/dental premiums deducted on a post-tax basis (after federal, state, or Social Security/Medicare taxes are withheld). This does not reduce your taxable gross wages. After initial enrollment, you may change your POP election only during the annual open enrollment period.

 

Part C - Medical Enrollment

If you want to participate in the benefit program, continue selecting your options from the choices below:

  • Select your type of enrollment (PPO, High Deductible, or Traditional).
  • Select which eligible dependents will be covered under your medical plan.

When 'Self only' is selected as the Medical type, the DENTAL option will be automatically selected as Self only. When selecting any dependent coverage other than 'Self only', the family members portion of the application will automatically expand for that change. More rows may be added for additional family members.

Remember - If you are an existing employee transferring employment from one agen​cy to another, you MUST re-enroll for all coverages. As part of your re-enrollment due to transferring, you may not change your benefit elections or elect previously declined coverages.

 

 

Part D - Dental Enrollment

If you want to participate in the benefit program, continue selecting your options from the choices below:

 

  • Self only
  • Self and dependents
    • Select who will be covered under your medical plan in the Family Members section.

Remember - If you decline dental coverage for your dependents, they cannot be added to your coverage until you have a qualifying event or Open Enrollment.     

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Section 4: Medical Coverage and Disability

If any of the next three categories apply, click 'Yes' to expand that category and enter the family member information.

  • If you need additional lines when adding dependents, click 'Add Row'. You may add as many lines as needed.  

    

 

Completed Application

Now that you have completed your application, scroll to the top and choose an option: Submit, Save, Cancel, Print, or Help.

You cannot submit this application unless changes have been made to fields other than the Application Information (Employee). If you do not make any changes before selecting the 'Submit' button, the following error message will be displayed: "No change has been made to this application. Please make a change and try again".

If OGI reviews your application and 'Declines' it, they must add a 'Comment' that is available to view by opening your application and clicking the 'Comments' button at the top.

  • Submit - will re-direct you to a Premium Only Plan Election, if you changed your plan from Pre-Tax to Post-Tax or vice versa. Please read the agreement and select 'I Accept' or 'I Do Not Accept'.  If you select 'I Accept', you will again be re-directed to the Statement of Understanding. Please read the agreement and select 'I Accept' or 'I Do Not Accept'. When the 'I Accept' button is pressed, the following message is displayed: "To view your submitted application, go to Views > My Self-Service. For additional information, contact the Office of Group Insurance".
  • Save - will save your document in a draft status and the following message is displayed: "Online enrollment application has been saved as a Draft. To complete and submit your enrollment application, go to Views > My Self-Service. For additional information, contact the Office of Group Insurance".
  • Cancel - you will receive the following message: "You have chosen to exit without saving your changes. If you wish to do this, press OK. By choosing OK, you will be taken back to the Self-Service Views. If you choose Cancel, the Medical and Dental Enrollment application remains open.
  • Print - sends your print request to a designated printer.
  • Help - will open the Division of Statewide Payroll (DSP) user manual. The manual will open to the Employee Self-Service Medical and Dental Enrollment information.
  • Delete - once a document has been saved or submitted there will be a 'Delete' button displayed in the top navigation frame.