Guidelines for setting eligibility

You determine when and how your employees are eligible for coverage, and we determine who can enroll as a covered dependent. Your eligibility rules are set for your entire plan year. If you'd like to make changes, you must wait until your renewal period.

Here are some eligibility guidelines and requirements:

Employee eligibility

To determine eligibility, your company may:

• Set an established number of hours per week an employee must work to qualify as a full-time (or even part-time) employee
• Establish a "waiting period, " such as 60 or 90 days, until a new employee qualifies for health coverage
• Decide when coverage will end if an employee becomes disabled or is laid off/terminated

Dependent eligibility

Dependents must be:

• Legally married to the employee (unless you offer benefits to domestic partners)
• An unmarried child of the employee (including stepchild, legally adopted or natural child or child placed for adoption) or a child who is the employee/spouse's court-appointed permanent or limited (other than a temporary) guardian
• Under the age of 26. (Coverage continues until his/her 26th birthday.)
• An unmarried incapacitated child over the maximum ages described above. (We must receive proof that the dependent is incapacitated within 31 days after the dependent reaches the maximum age for dependent children. After that, we can ask for proof only once each year.)

Other eligibility

Mid-market (51-99 eligible employees) and large (100+ eligible employees) groups may opt to provide coverage for:

• Early retirees (not yet eligible for Medicare)
• Retirees (eligible for Medicare on the basis of age)
• Sponsored dependents
• Domestic partners (also available for small groups)
• Surviving spouses

See your group agreement for coverage details and requirements.