Human Resources > :: Eligibility Requirements
:: Eligibility Requirements

 

  • Employees - faculty and staff occupying permanent full-time positions who work at least 30 hours a week are eligible for insurance benefits.
  • Eligible Dependents - you may cover your lawful spouse, or a former spouse required to be covered by a divorce decree or court order, but not both. If a spouse is also an employee of a South Carolina state-covered entity, the spouse cannot be covered as a dependent and must carry their own coverage, and only one of you may carry coverage for dependent children.

Children - you may cover an unmarried child under 19 years of age (or under age 25 if a full-time student) and who is principally dependent upon you for maintenance and support, provided the child is:

  • the natural or adopted child, stepchild, foster child or child for whom the subscriber has legal custody and who resides in the subscriber's home in a parent-child relationship; or
  • for whom the subscriber provides support and maintenance due to a court order.

Other children - An incapacitated unmarried child who is incapable of self-sustaining employment because of a disability and who is principally dependent on you for support (incapacity must be established prior to age 19) may also be covered.

Effective Dates

Coverage begins on the first day of the month the employee commences active employment if the employee commences active employment on the first working day of the month. Otherwise, coverage commences on the first day of the following month.

Enrollment Changes

Eligible employees have 31 days from your date of hire to enroll yourself and eligible dependents in the College's insurance plans. After 31 days from your hire date, you may make changes only on the following occasions:

  • Qualified Events: You may make certain changes throughout the year within 31 days of a qualified event. Qualified events include: marriage, birth, adoption or placement, loss of group health plan coverage, divorce/legal separation, death of the covered employee, loss of dependent's eligibility for coverage, etc. Documentation is required for certain events.
  • Annual Enrollment: Every year during the month of October, you may change from one health plan to another, enroll in, or cancel the MoneyPlu$ premium feature. You must enroll or re-enroll each year in the MoneyPlu$ Medical Spending Account or the MoneyPlu$ Dependent Care Spending Account in order to take advantage of this benefit. Changes made during the annual enrollment period are effective January 1 of the following year.
  • Open Enrollment: Open Enrollment is held during October in odd years (2003, 2005, etc.) In addition to the changes allowed during annual enrollment, you may make these changes:
    1. enroll yourself and/or eligible dependents in a health/dental plan without providing medical evidence of good health, subject to an 18-month pre-existing condition waiting period;
    2. drop health coverage for yourself or dependents;
    3. enroll or drop dental coverage for yourself or dependents.
Changes made during Open Enrollment are effective January 1 of the following year.
Consolidated Omnibus Reconciliation Act 1985 (COBRA): If you lose health and/or dental coverage due to termination of employment or reduction in hours, or your dependents are no longer eligible for coverage, coverage for you and/or your dependents may be continued under COBRA. A spouse or dependent of an active or retired employee may continue coverage if the termination of coverage falls within COBRA guidelines. You will receive information on COBRA when you initially enroll in a health and/or dental plan.
Certificate of Creditable Coverage: Terminated subscribers will receive a certificate of creditable coverage unless they are eligible for coverage in another classification such as transferring to another state-coverage entity. This certificate may be used to reduce the preexisting period of your next employer's health insurance plan. If you and/or your dependents are enrolling in a state health plan for the first time, you are responsible for obtaining and submitting a certificate of creditable coverage with your enrollment form. Preexisting Condition Definition Use by Plans

Health: Any medical condition, regardless of the cause of the condition, for which medical advice, diagnosis, care or treatment was recommended or received by a licensed health care provider or practitioner in the six months preceding the covered person's enrollment date under the plan. Benefits for the preexisting condition ar payable only for treatment rendered 12 months (18 months for a late entrant) after the enrollment date of a covered person. If you have been insured previously, you may reduce the preexisting condition period by providing certification of prior health insurance coverage provided the break in coverage is 62 days or less.




 

Trident Technical College, Copyright ©2011