Instructions for the Domestic PSC Health and Dental Plan
Note – Domestic employees are those stationed within the United States borders.
Initial Eligibility Period
An employee who is hired into a full-time position will have an Initial Eligibility Period during which they are eligible to join for coverage. This coverage will begin on the 1st day of the month following 30 days of employment. This Initial Eligibility Period will run from the date of hire until the 1st of the month following the 30 days of employment. This is a one-time opportunity to join the plan.
Non-members of the PSC Health plan, who have met Initial Eligibility Period requirement, may qualify for coverage during the plan Open Season. This runs from January 1 through January 31 each year.
An employee who has met the Initial Eligibility Period requirement may be permitted to join or adjust coverage within 30 days of one of the following Qualifying Events:
- change in marital status,
- change in family status,
- change in job status for employee or spouse, which causes a loss of coverage,
- transfer of jobsite from overseas to the U.S.
Any of these qualifying events could 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. These changes are subject to verification and approval by the insurance company.
** Please note that termination of Individual Coverage is not a Qualifying Event.**
If an employee has met the Initial Eligibility Period requirements and is currently covered under a COBRA plan from a previous employer, that person may join the plan as of the first of any month they choose while the COBRA coverage is in force.
Membership in both the health and dental plan 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.
How do I join?
At the bottom of this page, you will find a series of requirements for participation in the program. Once you have recognized these, you will be led to a page with a choice of enrollment forms for the health or dental plans. You will need to complete the appropriate form, and send the completed pages to our office via either:
email to Beth Johnson at firstname.lastname@example.org or
by fax to our office at 540-428-7090.
Once the enrollment form has been sent, you will need to follow the instructions below which are specific to a number of the offices and or branches of either The State Department or USAID. 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 540-428-2089 or by e-mail at email@example.com for further instructions.
How do I pay?
If you are employed by USAID, OFDA or another group affiliated with USAID:
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 sending your application via fax or email, please mail the premium to Bowman Gaskins Financial Group, 75 West Lee St., Suite 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. Any questions about payments or applications can be directed to Bill Stafford at USAID. Bill Stafford is located in Room B 3.6-184 DCHA-FFP in the Ronald Reagan Building. His phone number is 202-712-5951; fax is 202-216-3406; e-mail at firstname.lastname@example.org
Complete following Salary Reduction Agreement form (SF 1198) and return to Maria Rumambi. If you have any questions about your contract, you may direct these to Maria Rumambi at USAID. Maria Rumambi is located Agency for International Development, 1300 Pennsylvania Avenue NW, SA-44, Room 429H, Washington, D.C. 20523. Her phone number is (202) 567-5221; fax is 202-216-3039; e-mail at email@example.com. Send all documents and/or inquiries related to USAID US PSC’s’ Health Insurance Plan: firstname.lastname@example.org . This mailbox is monitored by the USAID PSC Support Team.
Click here to download form SF1198 Form.
If you are employed through Department of State or one of the Branches:
First month premium
Due to the delay in beginning a payroll deduction, the first month’s premium payment needs to be made by check. Once you have sent your application, 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.
If you are employed by OBO:
Print and complete payroll deduction form found below. Sign and return the original to Tarita Harris at OBO. Tarita Harris 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 703-516-1811, her fax is 703-875-5771; e-mail at email@example.com.
If you are employed by INL:
Print and complete enrollment form found below. Sign and return the original to Dominique Chittum at INL. She is located in U.S. Dept. of State, 2401 E Street, N.W. Washington, D.C. 20037, INL/EX/GAPP. Her phone number is 202-736-9149; e-mail at firstname.lastname@example.org.
If you are employed by OIG:
Print and complete enrollment form found below. Sign and return the original 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 email@example.com.
If you are employed by ISN:
Print and complete enrollment form found below. Sign and return the original to Dan Lowe 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-; his e-mail is firstname.lastname@example.org.
Click here to download form SF1199a form.
You will need to complete a Carefirst Enrollment form for any enrollment or change activity. This may be accessed by clicking on the area that says “Agree – Go to application” found at the bottom of this page.
Full benefit summaries and short executive summaries of each of these plans may be found on the Healthplan and Prescription Plan page.
For further information or questions, you may reach us by phone at 540-428-2089 or e-mail Beth Johnson at email@example.com.
- This benefit is not a Department of State or USAID sponsored benefit.
- The employee is responsible for prepaying all premiums by the first of the month.
- Salary reduction is the only acceptable way of paying premiums after the initial enrollment payment.
- 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 – Go to application process
Disagree – We are sorry. It is a requirement of participation in the program that a member agree with these conditions in order to enroll in the program.
If you have question, Contact Us.