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Eligibility & Enrollment
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Who is Eligible to Join the Benefit Plan?
You and your dependents are eligible to join the health and our company welfare benefit plans if you are a full-time employee regularly scheduled to work 30 hours per week. You must be enrolled in the plan to add dependent coverage.
Who is an Eligible Dependent?
• Your spouse to whom you are legally married • Your dependent child under the maximum age specified in the Carriers’ plan documents including: • Natural child • Adopted child • Stepchild • Child for whom you have been appointed as the legal guardian
*Your child’s spouse and a child for whom you are not the legal guardian are not eligible.
The Dependent Maximum Age Limits is up to age 26. The dependent does not need to be a full-time student; does not need to be an eligible dependent on parent’s tax return; is not required to live with you; and may be unmarried or married. Once the dependent reaches age 26, coverage will terminate on the last day of the birth month. A totally disabled child who is physically or mentally disabled prior to age 26 may remain on the if the child is primarily dependent on the enrolled member for support and maintenance.
When Do Benefits Become Effective?
Your benefits become effective on the first day of the month following your 60 days as a full-time employee with Plateau.
Annual Open Enrollment?
Each year during the annual Open Enrollment Period, you are given the opportunity to make changes to your current benefit elections. To find out when the annual Open Enrollment Period occurs, contact Human Resources.
Qualifying Event Changes
You are allowed to make changes to your current benefit elections during the plan year if you experience an IRSapproved qualifying change in life status. The change to your benefit elections must be consistent with and on account of the change in life status. IRS-approved qualifying life status changes include: • Marriage, divorce or legal separation • Birth or adoption of a child or placement of a child for adoption • Death of a dependent • Change in employment status, including loss or gain of employment, for your spouse or a dependent • Change in work schedule, including switching between fulltime and part-time status, by you, your spouse or a dependent • Change in residence or work site for you, your spouse, or a dependent that results in a change of eligibility • If you or your dependents lose eligibility for Medicaid or the Children’s Health Insurance Program (CHIP) coverage • If you or your dependents become eligible for a state’s premium assistance subsidy under Medicaid or CHIP If you have a life status change, you must notify the company within 60 days for changes in life status due to a Medicare or CHIP event and within 31 days of the other events.
If you do not notify the company during that time, you and/or your dependents must wait until the next annual open enrollment period to make a change in your benefit elections.
Please note, loss of coverage due to nonpayment or voluntary termination of other coverage outside a spouse’s or parent’s open enrollment is not an IRS-approved qualifying life event and you do not qualify for a special enrollment period.
