Eligibility Guidelines
Employees
Full-Time Employees
Full-time employees working 40 hours per week are eligible for health insurance and all other benefits beginning the first of the month after hire date unless hire date falls on the 1st of the month, then benefits start immediately.
Employees that work 30 hours per week as defined by the Affordable Care Act are eligible for medical and prescription coverage only.
Working Spouse
Spousal carve-out is a plan provision that restricts access to medical coverage for the spouse of an employee who is eligible for medical coverage through their employer. Employees with a working spouse who have access to employer-sponsored medical coverage will not be eligible to enroll his/her spouse in NEOMED’s medical coverage. This does not restrict access to dental or vision coverage.
Spouses Working at NEOMED:
Married employees that both work at NEOMED can elect individual, spouse, or family coverage.
Dependents
An eligible dependent may be:
- Your legal spouse
- A dependent child until the child reaches his or her 26th birthday; includes:
- Natural biological child;
- Step child;
- Legally adopted child or a child legally placed for adoption
- Child for whom the Subscriber or the Subscriber’s spouse is a legal guardian or as otherwise required by law
- A child who is considered an alternate recipient under a Qualified Medical Child Support Order
- Your dependent child who is Disabled either mentally or physically may continue beyond the day the child otherwise ceases to be a Dependent under the terms of the plan.
Making Enrollment Changes during the Year
In most cases, your benefit elections remain in effect until the next open enrollment period. The Annual Benefit plan year is January 1 to December 31. To make changes outside of the open enrollment period you must incur an approved family status change. Approved family status change events include:
- Birth, Adoption
- Marriage, Divorce
- Death of spouse or other Dependent
- Child Medical Support Orders
- Loss of eligibility under another health plan
If you think you may have a family status change that would allow you to make changes to your coverage, you MUST notify Human Resources within 30 days of Qualifying Event and supporting documentation is required. Failure to make timely notice would require you to wait until the next open enrollment.