For Groups Headquartered Domestically

Employee Eligibility

We will allow employers to cover employees who work 20 hours or more. It includes self-employed individuals, a sole proprietor, or a partner of a partnership if the sole proprietor or partner is included as an employee under a health care insurance plan of a small employer.

Employees/individuals not eligible for coverage include temporary employees, seasonal employees, substitute employees, independent contractors, uncompensated employees, volunteers, retirees, inactive owners, officers who are not active, managing members who are not active, investors or shareholders who are not otherwise eligible, and silent partners. Retirees are not eligible for medical, dental, life and disability coverages.

Regarding Life and Disability, employees who are both disabled and away from work on the date their insurance would otherwise become effective will become insured on the date they return to active full time work one full day.

Dependent Eligibility

Spouse or domestic partner. If both employee and spouse/domestic partner work for the same company they may enroll together or separately.

Children

Medical and Dental Dependents 

• Children, as defined in plan documents in accordance with state and federal law, are eligible for medical and dental coverage up to the end of the month when turning age 26, regardless of financial dependency, employment, eligibility of other coverage, student status, marital status, tax dependency, or residency. This requirement applies to natural and adopted children, stepchildren, and children subject to legal guardianship.
  
• Children eligible for coverage through both parents cannot be covered by both parents under the same plan.
  
• When the child works for the same company as the parent, the child may enroll separately as an employee OR as a dependent under the parent’s plan.
• Grandchildren are eligible if court-ordered. A copy of the court order must be submitted.

Life

• Dependent children are eligible from birth to age 26.
• Dependents are not eligible for AD&D and disability.
• For medical and dental, dependents must enroll in the same benefits as the employee (participation is not required).
• Employees may select coverage for eligible dependents under the dental plan even if they select single coverage under the medical plan.
• Individuals cannot be covered as an employee and dependent under the same plan.

Effective Date

Effective date must be the 1st of the month. The effective date requested by the employer may be up to 60 days in advance.

For Groups Headquartered Internationally

Employee Eligibility

This is a Local national plan designed for US citizens residing and working in the United States, employed by a non-US Headquartered Company.

No more than 10% of the enrollment residing in the United States can be non-US Locals (Inpats).

Ineligible employee – employees/individuals not eligible for coverage include temporary employees, seasonal employees, substitute employees, independent contractors, uncompensated employees, volunteers, retirees, inactive owners, officers who are not active, managing members who are not active, investors or shareholders who are not otherwise eligible, and silent partners.

Retirees are not eligible for medical and dental.

Dependent Eligibility

Spouse or domestic partner. If both employee and spouse/domestic partner work for the same company, they may enroll together or separately.

Domestic partners (same or opposite sex) and their eligible children are covered as eligible dependents. An affidavit is not required. The plan sponsor is responsible for determining whether the domestic partner is eligible.

Medical and Dental Dependents:

• Children, as defined in plan documents in accordance with state and federal law, are eligible for medical and dental coverage up to the end of the month when turning age 26, regardless of financial dependency, employment, eligibility of other coverage, student status, marital status, tax dependency, or residency. This requirement applies to natural and adopted children, stepchildren, and children subject to legal
• Children eligible for coverage through both parents cannot be covered by both parents under the same
• When the child works for the same company as the parent, the child may enroll separately as an employee OR as a dependent under the parent’s
• Grandchildren are eligible if court-ordered. A copy of the court order must be submitted.
• For medical and dental, dependents must enroll in the same benefits as the employee (participation is not required).
• Individuals cannot be covered as an employee and dependent under the same plan.

Effective Date

Effective date will follow the selected benefit waiting period (BWP) selected by the group. The group admin can request to waive the BWP but it must waive the entire BWP and not a partial amount, meaning coverage would be effective the employees' DOH. For employees moving from overseas to the United States, their original date of hire will apply when calculating their BWP and effective date.