ENROLLMENT AND ELGIBILITY
Get started with your SIHO benefits by exploring your options and choosing the coverage that works best for you.
Completing Your Enrollment
Review your benefit options below and submit your elections through Paycom Employee Self-Service, or on the designated benefit sites.
Paycom
- Enroll in your medical, dental, and vision coverage benefits.
- You can also make your FSA elections through Paycom. If enrolled in a High-Deductible Health Plan, you may also set your HSA payroll contributions.
401(k) Savings Plan
SIHO makes saving for retirement simple.
- Employees not currently enrolled will receive an automatic enrollment letter with opt-out instructions.
- Current participants can review investments, update contributions, or change beneficiaries at 401k.com.
Pet Insurance
- SIHO Insurance Services is excited to offer you pet health insurance for your cat or dog at a discount.
- You can enroll in or change your pet insurance at any time during the year.
ELIGIBILITY GUIDELINES
Employees:
- Health Plan - you have been employed for 60 days.
- Dental/Vision - first day of the month following your hire date.
- You are regularly scheduled to work 30 hours or more a week.
Dependents:
- Legal spouse
- Dependent children shall include natural children of the employee, adopted children, or children placed with a covered employee in anticipation of adoption. Step-children who reside in the Employee’s household may also be included as long as a natural parent remains married to the employee and also resides in the Employee’s household.
- Dependents are covered on Health, Dental, and Vision until age 26.
- Disabled child
Employees are responsible for notifying Human Resources within thirty-one (31) days of the time a dependent becomes eligible or ineligible for benefits. Please contact Human Resources with any questions or for more information about eligibility.
COORDINATION OF BENEFITS
Some employees may be eligible for benefits under another medical insurance plan in addition to the insurance coverage offered through SIHO. Benefit less Benefit Coordination of Benefits is used by SIHO. This means that, while you may submit charges for a medical service to both of your insurance companies, the total amount paid by both companies will never exceed the maximum amount that would be paid if the insurance through SIHO were your only plan. Members who are secondary on the SIHO Health Plan are not eligible for the VBID program. When SIHO is the Secondary plan and a bill comes in after being filed with the Primary carrier, SIHO will only pay up to the amount SIHO would have paid in the absence of a Primary plan. For example, a $100 bill, when submitted to the Primary carrier, yields a reimbursement to the employee of $80 from that carrier. SIHO adjudicates the bill and, in the absence of a Primary plan, would have reimbursed $80. In this case, SIHO would subtract what the Primary plan has paid, and the additional reimbursement would result in a $0 payment.
WORKING SPOUSE RULE
- If a spouse of an eligible employee is employed with a company other than SIHO which offers group medical insurance coverage and that spouse is eligible for that plan, the spouse will not be eligible for the SIHO Health Plan.
- If the spouse is employed with a company that does not offer group medical coverage, the spouse may be enrolled in the SIHO plan as primary at the family rate which is currently in effect. (A statement from the spouse’s employer that verifies they have no coverage available with that employee will be required).
- All employees enrolling a spouse will be required to indicate on the enrollment form that their spouse does not have eligibility from another health insurance plan.
If a spouse becomes eligible during the contract year, the spouse will have 30 days from the first date of eligibility to enroll in the spouse's health plan and will no longer be eligible under the SIHO Health Plan. If SIHO becomes aware of a spouse’s eligibility after 30 days, all health benefit coverage will be terminated retroactively to the date of eligibility and any claims paid will be refunded to the SIHO Health Plan.
NOTE: Working Spouse Rule does not apply to Vision and Dental Coverage.
