Read our frequently asked questions for fast answers.
Still need help? Call us at 1-866-740-4006
or visit www.paisc.com
How do I enroll?
YEnrolling in the EssentialCARE limited benefit plan is easy. You can enroll by completing an EssentialCARE enrollment application and returning it to your manager.
When can I enroll in the plan?
As a part-time or full-time employee, you are able to enroll in the EssentialCARE program within 30 days of your hire date or your employer’s annual 30 day open enrollment period. If you do not enroll during one of these time periods, you will have to wait until the next annual open enrollment, unless you have a qualifying life event. You have 30 days from the date of the qualifying life event to enroll.
What is a qualifying life event?
A qualifying life event is defined as a change in your status due to one of the following:
- Marriage or divorce
- Birth or adoption of a child(ren)
- Death of an immediate family member
- Medicare entitlement
- Employer bankruptcy
- Loss of dependent status
- Loss of prior coverage
If you experience a qualifying life event, you must submit documentation of the event along with a change form requesting the change within 30 days of the event. In addition, you may request a special enrollment (for yourself, your spouse, and/or eligible dependents) within 60 days (1) of termination of coverage under Medicaid or a State Children’s Health Insurance Program (SCHIP), or (2) upon becoming eligible for SCHIP premium assistance under this Fixed Indemnity medical benefit.
Are dependents covered?
Yes. Eligible dependents include your spouse and your children up to age 26.
When does coverage begin?
Coverage will begin the Monday following a payroll deduction and continues as long as you have a deduction from your paycheck. Please review your check stub for deductions. If you miss a payroll deduction, to avoid a break in coverage, you may make direct payments to PAI. After six consecutive weeks without a payroll deduction or direct premium payment, coverage will be terminated and COBRA information will be sent at that time.
If I complete an enrollment form, but do not get placed on assignment right away, will I have to complete a new form?
After six months if there has not been a deduction from your paycheck, please fill out a new enrollment form. Missing information will delay the process.
Can I make changes or cancel coverage?
You may cancel or reduce coverage at any time unless your premiums are deducted pre-tax. You will only have 30 days from your hire date to enroll, add additional benefits or add additional insured members. After this time frame, you will only be allowed to enroll, add benefits or add additional insured members during your annual open enrollment period or within 30 days of a qualifying life event.
(Please refer to the “PLEASE NOTE” section on the last page of your enrollment form to see if deductions are Post-Tax or Pre-Tax)
How can I make changes?
To make changes to your current benefits or cancel coverage by telephone call (866) 740-4006. Remember, it make take up to two or three weeks for the changes or cancellation to be reflected on your paycheck. Coverage will continue as long as you have a paycheck deduction.
Is there a pre-existing clause for the Fixed Indemnity Medical Benefit?
There are no restrictions for pre-existing conditions for the fixed indemnity medical plan. Even if you were previously diagnosed with a condition, you can receive coverage for related services as soon as your coverage goes into effect.
Are maternity benefits covered?
Yes, maternity benefits are covered the same as any other condition under this plan.