Small Group Health plans typically have specific guidelines that will determine eligibility for your employees. It is important to understand all of these guidelines so that you can inform your employees ahead of time of what they will need to join your plan. There are many different types of guidelines, depending on the status of an employee, or yourself, for eligibility with a group health plan with Anthem Blue Cross.
Your full-time employees will be considered eligible, so long as they work at least 30-hours per week, and are employed by you on a permanent basis. The employee may not be a volunteer and must receive payment for their work.
Part-time employees must generally work at least 20 hours per week, and must be employed on a permanent basis. In addition, these part-time employees may not work over 29 hours a week and they must be paid for this work. You will not be required to offer any health coverage to part-time employees, but if you wish to, they must follow these eligibility requirements.
If you are sole proprietor, a partner or a corporate officer, in order to be considered eligible for your group health plan you must work for your company at least 20 hours each week.
Employees that are considered seasonal, temporary or substitute workers will not be eligible for your group health plan. In addition, any workers that are compensated on a 1099 basis, such as freelancers, will not be eligible.
In order for a dependent to eligible for coverage under your group health plan, they must be either a lawful spouse, an unmarried child that is under the age of 19 or an unmarried child between 19-24 who is a full-time student. A dependent child may be your natural or legally adopted child of either yourself or your spouse. In some cases, domestic partners may receive dependent eligibility, but restrictions may apply. You will need to check with your representative for more information.
Employer Waiting Periods
You will be able to select a waiting period for new employees before they become eligible for coverage with your group health care plan. If you prefer to allow a new employee to become eligible within one month of their start date you can select that option, or if you prefer, you can set a one to six month waiting period for new-hires.
All policies will take effect for your group either on the first or the fifteenth of the month. If you purchase a policy in between these dates, you will need to wait for the next available date for your coverage to begin. For example, if you purchase a policy on the 3 rd of the month, it would not become effective until the 15 th.
If you have any employees or their dependents who were eligible for coverage but decided to wait, they will be forced to adhere to a twelve month waiting period should they change their mind and join the group policy later on. It is important to educate your employees on this clause so that they can join with the rest of the group and avoid this problem.
Wait Period for Preexisting Conditions
If an employee received medical care, treatment, was diagnosed or received advice for a medical condition six months before the effective date of coverage, this will be considered a preexisting condition. This period may vary, and you will need to check with your representative for more information.
These are just a few of the enrollment guidelines that you can expect. Each plan may have different requirements. It is important to thoroughly review this information before signing any policy, to ensure that you are completely aware of any and all restrictions or guidelines.
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