ELIGIBILITY & LIFE EVENTS
Embedded Files
Understanding Your Benefits
Understanding your employee benefits is key to making the most of your coverage, particularly when it comes to eligibility and special enrollment periods. Eligibility typically depends on factors like your employment status, hours worked, or waiting periods set by your employer. It’s also important to know about special enrollment periods, which allow you to make changes to your benefits outside of open enrollment if you experience a qualifying life event, such as getting married, having a child, or losing other coverage. Staying informed ensures you can access the benefits you need when life changes occur.
Benefit Eligibility Explained
Benefit Eligibility Explained
In order to access your company’s comprehensive employee benefits package, there are specific eligibility criteria designed to ensure inclusivity and support for various family structures.
To qualify, individuals must be employed as full-time staff, dedicating a minimum of 30 hours per week.
This coverage extends beyond the employee to include their legally married spouse, natural or adopted children up to the age of 26, irrespective of their student or marital status.
Additionally, coverage encompasses stepchildren, children under the employee's guardianship, and those under a qualified medical child support order.
We extend our support to disabled children aged 19 or older, recognizing the importance of inclusive care. Moreover, children placed in the employee's physical custody for adoption are also eligible, emphasizing a commitment to family well-being and the diverse paths to parenthood.
These criteria reflect a dedication to providing a robust benefits package that acknowledges and supports the diverse needs of employees and their families.
Who is Eligible to Receive Benefits
Who is Eligible to Receive Benefits
Full-Time Employee (+30 Hours a Week)
Legally married spouse
Natural or adopted children up to age 26 regardless of student or marital status
Children under your guardianship
Stepchildren
Children under a qualified medical child support order
Disabled children 19 years or older
Children placed in your physical custody for adoption
Who is not Eligible?
Who is not Eligible?
Divorced or legally separated spouse
Common law Spouse, even if recognized by your state
Domestic partners, unless otherwise approved by your employer
Foster children
Sisters, brothers, parents or in-laws, grandchildren, etc.
Changes in Household
Changes in Household
If you or anyone in your household:
Gets married
Has a baby, adopts, or places a child in foster care
Loses health insurance due to a divorce or legal separation
Passes away
Changes in Residence
Changes in Residence
If you move to:
a different ZIP Code or county within the U.S.
The U.S. from outside the country
Or, if you move to or from:
A place you attended school
A place you both live and work (if you are a seasonal worker)
A shelter or other transitional housing
Loss of Health Insurance
Loss of Health Insurance
If you or anyone in your household loses health coverage from:
An employer
An individual health insurance plan
Medicaid or Children's Health Insurance Program (CHIP)
Medicaid
A family member's plan (for example, dependents turning 26 years old)
Other Situations
Other Situations
If you or anyone in your household:
Are offered a Health Reimbursement Arrangement (HRA) or a Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) through your employer
Gains membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
Becomes a US citizen
Leaves incarceration
Starts or ends service as an AmeriCorps State and National, Volunteers in Service to America (VISTA), or National Civilian Community Corps (NCC) member
Page updated
Report abuse