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1. Who is an eligible subscriber?

Eligible subscribers must be US citizens, permanent residents, or non-immigrants whose authorization status permits employment.

New hires/rehires are eligible to enroll in the group health plan of a participating school district if:

1. You are an eligible employee; AND
2. You are performing the essential job duties according to your job description    pursuant to the collective bargaining agreement or other contractual obligations of your position; AND
3. You are receiving your contractual salary if a salaried employee or your hourly rate if an hourly employee; AND
4. You are working a minimum of 20 hours per week if hired as a full-time employee or averaging a minimum of 17.5 hours per week if hired as a part-time employee; AND
5. You are meeting any additional eligibility requirements of your school district.

When all of the above criteria are met, you may be considered an active and eligible participant of the health plan. However, if a participant is not actively working on the effective date of coverage, coverage will be delayed for the participant and his/her dependents until the participant begins work as a new hire or returns to work as a rehire. All required enrollment forms must be submitted within 30 days of becoming an eligible employee. 

2. When can I enroll in the Genesee Area Healthcare Plan?

• New hires/rehires that meet all the eligibility requirements listed in Question 1 above must enroll within 30 days of their start date.

• If an active and eligible employee does not enroll himself/herself or their dependents when initially eligible, he or she will have to wait until the annual Open Enrollment Period which is the month of June with a July 1st effective date.

• The following events allow the subscriber to add a dependent to their coverage within 30 days of the qualifying event:

  • Marriage (the spouse and any stepchildren)

  • Birth (the newborn)

  • Adoption (the adoptive or proposed adoptive child)

  • A Qualified Medical Child Support Order is issued.

3. I am going to adopt a child. How do I get this child on my plan?

Subscribers must complete a Dependent Adoption Form.  Completion of a Dependent/Adoption form must be received within 60 days of the following events to be effective on the requested date:

• Child(ren) adopted or pending adoption effective as of the date of birth or as of the date legal proceedings were started.

• Foster child (Welfare Department assigned under State law).

• Child for whom the subscriber is a legal guardian or has legal custody (court-stamped documentation will be required).

• Any other child who lives in the household who is claimed as a dependent on the employee/subscriber’s current federal income tax return.

4. I have a disabled child. What are the guidelines to make sure he remains on my plan after age 19.

An adult child who is incapable of self-sustaining employment may be eligible to continue coverage beyond the age where coverage would otherwise terminate.  One of the following conditions must cause the incapacity:

• Mental illness

• Developmental disability as defined in the NYS Mental Hygiene Law

• Physical handicap

• The child must also meet all of the following conditions:

• The condition occurred before the dependent reached the maximum age under the certificate

The child was covered at the time he or she would have otherwise reached the maximum age under the certificate:

• The condition continues to exist

• The child remains unmarried

• The child remains dependent upon the subscriber for support

• The application for coverage as a disabled dependent is also dependent upon the review by and approval of, the Medical Director at Excellus BCBS.

Documentation requirements include both of the following:

A completed Adult Disabled Dependent Form must be completed and signed by both the subscriber and the medical doctor.  This application must be received prior to the dependent age limitation.