Eligibility and Enrollment
Who Is Eligible
Except as described below, you are eligible for coverage under the Health Care Program if you are classified by a participating employer as a regular full-time employee, or if you are classified by a participating employer as a regular part-time employee and you are expected to regularly work at least 30 hours per week.
You are not eligible for coverage if, at your date of hire, you: (i) are not expected to regularly work 30 hours per week; or (ii) you are classified by the participating employer as an intern who is hired into a position for which the customary annual employment is six months or less. However, you will become eligible for coverage if you are employed on average at least 130 hours per month during a "measurement period" (see "Appendix D: Special Eligibility Rules" for more information about how you can become eligible for coverage and when your coverage would start in this situation).
Individuals who are not classified by a participating employer as common-law employees, or who are covered by a collective bargaining agreement are not eligible for coverage. Individuals who are classified by a participating employer as independent contractors or leased employees are not eligible to participate, even if they are later re-classified as common-law employees of the participating employer.
You must regularly work the minimum required hours to keep your eligible status and your coverage, unless you qualify for continued coverage described in the "Continuing Coverage" section below or you remain eligible as described in "Appendix D: Special Eligibility Rules."
Coverage for Your Dependents
If you enroll for health care coverage, your eligible dependents can be covered also. The Plan Administrator will require satisfactory evidence of eligible dependent status, such as a marriage license and a completed Spousal Health Care Affidavit for a spouse (or a federal tax return for a common-law spouse), or a birth certificate for a child.
If both you and your spouse are eligible for coverage as employees, one of you should elect family coverage and the other will be covered as a dependent. If the spouse who is enrolled as an employee terminates employment, the spouse who is enrolled as a dependent will become the enrolled employee.
Working Spouse Rule
If your spouse works for another employer and is eligible for major medical health care coverage, he or she must choose at least single major medical coverage through his or her employer to have dependent coverage under the Health Care Program. The Health Care Program will provide only secondary coverage to the plan that covers your spouse. If your spouse does not enroll for the other employer's coverage, he or she will have nocoverage under the Health Care Program. Once your spouse obtains such other coverage, you can re-enroll your spouse for coverage under the Health Care Program in the manner as directed by the Plan Administrator. Your spouse's coverage will take effect as soon as administratively possible after the Plan Administrator's receipt of the re-enrollment and verification of the other coverage.
If you seek to enroll your spouse in Alliance Health Care Program coverage, you must complete and return a completed Spousal Health Care Affidavit. If you do not return a completed affidavit, your spouse will not be eligible for coverage.
Note: If you enroll for or continue your working spouse's coverage without his or her employer's coverage in effect and the Plan erroneously pays benefits for your spouse, you (the employee) must reimburse the Plan for its overpayment. The Plan may reduce your future benefits to collect this reimbursement.
The Working Spouse Rule, as described above, does not apply if your spouse is only eligible for health care coverage that is determined by the Plan Administrator to be a preventive-only coverage or supplemental coverage. In that case, your spouse does not have to enroll in his or her employer’s preventive-only coverage or supplemental coverage to have dependent coverage under the Health Care Program. However, if your spouse is eligible for major medical health care coverage in addition to preventive-only coverage and/or supplemental coverage, he or she must choose at least single coverage through his or her employer’s major medical health care coverage to have dependent coverage under the Health Care Program.
For purposes of this Working Spouse Rule, the following definitions apply:
- "Major medical health care coverage" provides coverage for a broad range of inpatient and outpatient health care services, as well as prescription drugs and preventive services. Major medical health care coverage covers conditions caused by accidents or illness.
- "Preventive-only coverage" provides coverage only for preventive services, such as immunizations, lab tests, screenings and other services that are intended to prevent illness or detect problems before you notice any symptoms. Preventive-only coverage does not cover any inpatient or outpatient hospital services, and does not cover conditions caused by accidents or illness.
- "Supplemental coverage" provides coverage for items and services that are not covered by major medical health care coverage, or that provides coverage for coinsurance, copays and deductibles under major medical health care coverage.
The Plan Administrator has full discretion and authority to interpret and apply these definitions.
Enrolling in Coverage
To enroll yourself and any eligible dependents for coverage, complete and submit a Benefit Election Form to your local HR representative within 31 days of becoming eligible.
Your local HR representative is also available to help you update your address, covered dependents, and coverage level to avoid a delay in benefit payments.
You may choose coverage for just yourself, or for you and your eligible dependents. You also have the option of waiving all health care coverage, or waiving only dental and/or vision coverage. If you waive any coverage, that choice applies to you and your dependents.
The coverage you choose will remain in effect until your coverage ends, or until you make new coverage elections during the next annual Open Enrollment period or following a qualified change in status (see "Changing Coverage Elections" for more information). If you waive coverage, your waiver will remain in effect until you make new coverage elections during the next annual Open Enrollment period or following a qualified change in status. Any elections must be made in the manner directed by the Plan Administrator.
Enrolling New Dependents or Dropping Ineligible Dependents
To add a new dependent to your coverage (e.g., after a marriage, birth, or adoption), you must enroll your new dependent within 31 days of the date he or she became eligible. Coverage for the dependent will then be effective as of the date he or she became your dependent.
If you do not meet this enrollment deadline, the dependent will not be covered by the Plan until you enroll the dependent during the next annual Open Enrollment period or following another qualified status change. An exception will be made for newborn or newly adopted children; if you fail to meet the 31-day enrollment deadline but still enroll the child by the last day of the calendar year following the year in which the child became your dependent, coverage for the child will then be effective as of the date he or she became your dependent.
If any of your dependents becomes ineligible for coverage (in other words, no longer meets the definition of an eligible dependents), you must notify your local HR representative or the Benefits Department before the date the dependent becomes ineligible or as soon as feasible afterwards.
Qualified Medical Child Support Orders
If you are eligible for coverage under the Plan, you may be required to provide coverage for a child of yours if the Company receives a Qualified Medical Child Support Order (QMCSO). A QMCSO is a judgment, decree, or order issued by a state court or agency that creates or recognizes the existence of an eligible child's right to receive health care coverage. A properly completed National Medical Support Notice will be treated as a QMCSO. The order or notice must comply with applicable law and must be approved and accepted as a QMCSO by the Plan Administrator in accordance with the Plan's procedures. The Plan's QMCSO procedures are available at no cost.
If the order is approved and accepted as a QMCSO, coverage for the child will be effective as specified for the Plan in the order. If the order does not specify an effective date for coverage under the Plan, coverage for the child will be effective on the first of the month following the date the order is received by the Plan Administrator.
A QMCSO must be filed with the Plan Administrator.