KANAWHA GROUP DENTAL PLUS

Dental Insurance Enrollment Procedures for the Employees of

DHHS

1) Employee must complete the application and payroll form and return both to your Benefit Representative’s office.

2) Benefit Representative must then forward the application to Advisors Financial Group and forward the payroll form to their payroll center for processing.

Eligibility Requirements

· New Employee (has 30 days from date of hire to enroll)

· Qualifying Events (some examples are loss of coverage from a spouse’s coverage, marriage, birth of a child, etc. 30 days from the date of event to enroll.

· Open Enrollment Period (for current active employees)

Policy Changes

ADDITIONS TO AN EXISTING POLICY- Another application must be completed marking change box at the top. Mail it with a payroll change form. Then it must be routed to your Benefit Representative. Additions can ONLY be done during open enrollment, or a Qualifying event.

REMOVAL OF DEPENDENTS – The employee must complete TOP SECTION of form 6016B Policy Service Request, then complete section G to remove dependents from the existing policy. Removals can be done at anytime.

CANCELLATION OF POLICY – The employee must first stop his payroll deduction, Kanawha cannot do this for them. Next, the employee needs to complete form 6016 B Policy Service Request, TOP SECTION along with Section K marked “Special Request” and then write in “Cancel Policy.” The employee must then mail it to Kanawha, P.O. Box 610, Lancaster, SC 29721. Cancellations can be done at anytime.

Important Contact Information

For questions concerning enrollment or policy information contact the agent, Advisors Financial Group at 1-800-334-1217.

For Policy Holder Service questions, contact Kanawha Insurance Company at 1-800-635-4252 extension 2518.

For questions concerning dental claims the EMPLOYEE must contact Kanawha at 1-800-635-4252 extension 2518. Due to changes in HIPPA laws only the employee will be able to get information on claims.

Important Contact Information

Advisors Financial Group Kanawha Policy Holder Service

P.O. Box 17388 800-635-4252 ext. 2518

Raleigh, NC 27619 Kanawha Insurance Company

919-844-1777 P.O. Box 610

Lancaster, SC 29721