- Eligibility for Health plan coverage for Active Employees is based on contributions made on your behalf by your employer.
- Contributions are held in a “dollar bank”, and used each month to determine and pay for your heath coverage.
- Once you become eligible, you are permitted to make self-payments to make up any deficit in your dollar bank, in order to remain covered.
When you initially qualify for coverage and annually thereafter, you must elect whether to cover the “Employee Only”, “Employee Plus” or, “Family” plan level of coverage and enroll accordingly. Employee Plus means either your spouse or your dependent children will be covered in addition to yourself.
- Your bank must be credited at the highest Plan Level within a six month period for you to achieve initial eligibility.
- If you fail to enroll, you will be placed in the Employee Only Plan Level until the next annual enrollment.
- If you don’t have sufficient funds in your dollar bank for the next month, and your Dollar Bank has at least $300 in it, you are permitted to pay the difference (due by the 10th of the month of coverage).
- If an Employee’s eligibility terminates due to insufficient Dollars Bank funds, non-payment of a self-payment required to continue coverage, or termination of coverage under COBRA or USERRA, coverage as an Active Employee may be reinstated in the following ways:
- Within 13 months after coverage ends, the Employee is properly credited with sufficient funds in his Dollars Bank account, received over a period of six months or less, to pay for one month of coverage at his Plan Level. Eligibility is reinstated and coverage is provided on the first day of the calendar month following the month in which the Dollars Bank reaches the required level.
- If more than 13 months elapse after coverage ends, the Employee again meets the initial eligibility requirements described above in Section 1.2.