Benefits Handbook (SPD)
Health Care
Participation
Eligibility and Enrollment
When Coverage Begins
Changing Coverage Elections
Situations That May Affect Your Coverage
When Coverage Ends
Continuing Coverage
Other Information About the Health Care Program
Definitions
Appendix A: QMCSO Procedures
Appendix B: Notice of Privacy Practices
Appendix C: Health Insurance Marketplace and Alternatives to COBRA
Appendix D: Special Eligibility Rules
Medical
Prescription Drug
Dental
Vision
Flexible Spending Accounts
Income Security
Retirement
Special Benefits
Policies

Appendix D: Special Eligibility Rules

This appendix describes the eligibility rules for employees who are not eligible for coverage under the rules described in the "Who is Eligible" section because, at their date of hire, they: (i) were not expected to regularly work 30 hours per week; or (ii) were classified by the participating employer as an intern who was hired into a position for which the customary annual employment is six months or less.

This appendix also describes the eligibility rules for employees who (i) have a job status change to a position in which the employee is expected to regularly work 30 hours per week; or (ii) have a job status change to a position in which he or she is not expected to regularly work 30 hours a week.

This appendix describes certain rules under which an employee who is regularly working for a participating employer can become eligible or continue to be eligible.  This appendix does not apply to any individual who is not regularly working for a participating employer.  Such individual will no longer meet the eligibility requirements for the Health Care Program. 

An employee who becomes eligible for coverage pursuant to this appendix will be considered an eligible employee for the applicable "stability period" (described below) during which such employee is eligible for coverage.

The Plan Administrator has the authority to interpret and apply the rules described in this appendix in accordance with applicable law, including the statutory, regulatory, and other guidance issued with respect to the determination of "full-time employees" for purposes of Section 4980H of the Internal Revenue Code.

For purposes of applying the rules described in this section, an employee who is terminated and rehired will be treated as a new employee upon rehire only if the employee was not credited with an hour of service with any participating employer for a period of at least 13 consecutive weeks immediately preceding the date of rehire or, if less, a period of consecutive weeks that exceeds the greater of (a) four weeks, or (b) the number of weeks of the employee’s immediately preceding period of employment.

The provisions in this appendix regarding continued eligibility for specific periods of time are subject to the termination events described in the "When Coverage Ends" section.

New Employees

If an employee is determined to have been employed an average of at least 130 hours per month over the 12-month period beginning on the employee's date of hire (the "initial measurement period"), the employee will become eligible for coverage as of the first day of the calendar month that begins after the one-year anniversary of the employee's date of hire, and will be eligible for the following 12 months (the "initial stability period"). Such employee's eligibility for coverage for periods after the initial stability period will be subject to the "standard measurement period" rules for ongoing employees, as described below. To begin coverage, the employee must complete and submit a Benefit Election Form to the employee's local HR representative within 31 days of becoming eligible, with coverage to begin as of the first day of the initial stability period.

Ongoing Employees

If an employee is determined to have been employed an average of at least 130 hours per month during a "standard measurement period," the employee will become eligible for coverage for the "standard stability period" that follows the standard measurement period. To begin coverage, the employee must complete and submit a Benefit Election Form to the employee's local HR representative within 31 days of receiving notice of eligibility, with coverage to begin as of the first day of the standard stability period.

A "standard measurement period" begins on November 1 of a calendar year and ends on October 31 of the following calendar year.

A "standard stability period" begins on January 1 of a calendar year and ends on December 31 of such calendar year.

An employee who is determined not to have been employed an average of at least 130 hours per month during a standard measurement period will not be eligible for coverage for the standard stability period that follows the standard measurement period (regardless of whether such employee was eligible for coverage during a previous standard stability period), though an employee who was eligible to participate during an initial stability period will remain eligible for that entire initial stability period.

Changes in Job Status

If an employee's job status changes to a position in which the employee is expected to regularly work 30 hours per week, such employee will become eligible for coverage. To begin coverage, the employee must complete and submit a Benefit Election Form to the employee's local HR representative within the 31-day period beginning on the date of the status change, with coverage to begin as of the date of the status change.

If an employee who is expected to regularly work 30 hours per week has a job status change to a position in which he or she is not expected to regularly work 30 hours a week, the following rules will apply:

  • If the change occurs before the employee has completed at least one standard measurement period, such employee will cease to be eligible for coverage as of the date of the status change. The employee's eligibility for the first standard stability period and subsequent standard stability periods will be determined in accordance with the rules for ongoing employees.
  • If the change occurs after the employee has completed at least one standard measurement period, such employee will remain eligible for coverage for the remainder of the current standard stability period if such employee was employed an average of least 130 hours per month during the standard measurement period associated with such standard stability period. Such employee will cease to be eligible for coverage as of the date of the status change if the employee was not employed an average of at least 130 hours per month during the standard measurement period associated with the current standard stability period. The employee's eligibility for future stability periods will be determined in accordance with the rules for ongoing employees.