PSC HEALTHPLAN

Domestic Plans

Eligibility and Enrollment Instructions for the

Domestic PSC Health and Dental Plan 

Note – Domestic employees are those stationed within the United States.

Eligibility:

 Full time employees have an initial eligibility period in which they are eligible to join for coverage which will begin on the 1^st day of the month following 30 days of employment.  Additionally, non-members may qualify for coverage during the plan open season, which runs from January 1 through January 31 each year.

 Also, an employee may be permitted to join or adjust coverage within 30 days of one of the following Qualifying Events:

 1)      change in marital status,

2)      change in family status,

3)      change in job status for employee or spouse,

4)      transfer of jobsite from overseas to the U.S.

 Any of these qualifying events will allow an employee to enroll or adjust coverage as of the date of the event.  All paperwork must be filed with plan administrators within 30 days of the event.

 Membership in both the health and dental programs is not a requirement.  If you would like to enroll in one or the other, this is allowable.  Also, you may enroll with a different status in one versus the other – i.e. you may enroll as a single on the health plan, and as a family under the dental plan.

 Enrollment:

How do I join?

The following instructions and forms contain all of the required paperwork to enroll in coverage under the Health or Dental Plans.  Please find your branch in the list below for points of contact and instructions about payroll deduction forms.  If your specific branch is not listed, please contact us at 877-472-7676 or by e-mail at agarrett@bowmangaskins.com for further instructions.

If you are employed by USAID:

Print and complete enrollment form found below. Sign and return the original to Bowman Gaskins Financial Group (BGFG) via facsimile at 540-428-7090, or return to Barry Burnett at USAID. Barry Burnett is located in Room 7.06-122 DCHA-FFP in the Ronald Reagan Building. His phone number is 202-712-0318; fax is 202-216-3039; e-mail at bburnett@usaid.gov.

Premium Payments

First month premium

Due to the delay in beginning a payroll deduction, the first month’s premium payment needs to be made by check.  If you are supplying a hard copy of your application to Barry Burnett at USAID, include the first month’s premium in the form of a check with your application. If you are sending your application via fax, please mail the premium to Bowman Gaskins Financial Group, 75 West Lee St.  Ste 102, Warrenton, VA 20186. All checks are to be made payable to Bowman Gaskins Financial Group and should note the enrollee’s Social Security Number on the memo line. 

Subsequent Premiums

Complete following Salary Reduction Agreement form (SF 1198) and return to Barry Burnett. Click here to download form SF 1198 in Adobe PDF format. (Use the back button on the browser to return to this page.)

If you are employed by OBO:

Print and complete enrollment form found below. Sign and return the original to Bowman Gaskins Financial Group (BGFG) via facsimile at 540-428-7090, or return to Abolade (AB) Thomas at OBO. AB Thomas is located in U.S. Dept. of State, 1701 N. Fort Myer Drive, Rosslyn OBO/RM/EX/HR Room L200 SA-6  Her phone number is 703-875-5346, her fax is 703-875-5771; e-mail at thomasas@state.gov. 

If you are employed by INL:

Print and complete enrollment form found below. Sign and return the original to Bowman Gaskins Financial Group (BGFG) via facsimile at 540-428-7090, or return to Barbara Stevenson at INL. She is located in U.S. Dept. of State, 2340 E Street, N.W. South Building, SA-4, Washington, D.C.  20036, INL/RM/HR.  Her phone number is 202-776-8735; her fax is 202-776-8989; e-mail at stevensonba@state.gov. 

If you are employed by OIG:

Print and complete enrollment form found below. Sign and return the original to Bowman Gaskins Financial Group (BGFG) via facsimile at 540-428-7090, or return to Dianna Wolridge at OIG. She is located at OIG, Department of State 1700 N. Moore Street Arlington, VA  22209.  Her phone number is 703-384-1812; her fax is 703-284-1966; e-mail at wolridged@state.gov.

 If you are employed by ISN:

Print and complete enrollment form found below. Sign and return the original to Bowman Gaskins Financial Group (BGFG) via facsimile at 540-428-7090, or return to Steven K. Robinson at ISN. He is located at ISN, United States Department of State, 2201 C Street N.W., Washington, D.C.  His  phone number is 202-647-1207; his e-mail is robinsonsk1@state.gov.

Premium Payments

First month premium

Due to the delay in beginning a payroll deduction, the first month’s premium payment needs to be made by check.  If you are supplying a hard copy of your application to your internal point of contact listed above, you will need to include the first month’s premium in the form of a check with your application. If you are sending your application via fax, please mail the premium to Bowman Gaskins Financial Group, 75 West Lee St.  Ste 102, Warrenton, VA 20186. All checks are to be made payable to Bowman Gaskins Financial Group and should note the enrollee’s Social Security Number on the memo line. 

Subsequent Premiums

Complete following Salary Reduction Agreement form (SF 1199a) and return to Barbara Stevenson. Click here to download form SF 1199 in Adobe PDF format. (Use the back button on the browser to return to this page.)

          Enrollment Form

 You will need to complete a new United Healthcare Enrollment form.  This may be accessed by clicking on the area that says “Agree Go to application” found at the bottom of this page.

Completed forms must also have a plan choice code noted BOLDLY in writing on the top of your application.  These codes are noted atop the plan descriptions, plan outlines or the price chart found below.  Your form should note one of the following codes:

                V5A    The HMO HSA Plan (local network only)

                Y3F     The Choice Plus EDGE plan (national network)

                 V3J      The Choice Plus PPO (national network)

                  P5420 Voluntary Dental Options PPO

Full benefit summaries and partial executive summaries of each of these plans may be found on the Plan Design Page.

For further information or questions, you may reach us by phone at 877-472-7676 or e-mail at agarrett@bowmangaskins.com

Disclaimer:

1. This benefit is not a Department of State sponsored benefit.

2. The employee is responsible for prepaying premiums.

3. Salary reduction is the only acceptable way of paying premiums after the initial enrollment payment.

4. If premiums are not received within 30 days of due date, coverage will be terminated back to the last paid-through date.

If you agree to these terms, please click “Agree” below to proceed to the Enrollment form. Please print the Enrollment form and fax to 540-428-7090.

AGREE  

                                                                                              DISAGREE

GO TO APPLICATION                                    

We are sorry. You must agree to these conditions in order to proceed to the Enrollment form. Please click on the “UP” button to go back to AGREE, or click on “HOME” to exit. Or send us a question below.

If you have any questions about this information please fill in box below with your question(s) and we will give you a reply within 48 hours. You must give us your email address so we can respond to you.