Qualifying Criteria
There are two ways to qualify for health insurance coverage as
a project-based employee under Open Health :
Qualifying as a New Participant
Qualifying as a New Participant
Work 130+ hours in
a calendar month
Qualifying as a
New Participant
a calendar month
Qualifying as a Continuing Participant
Qualifying as a Continuing Participant
Qualifying as a
Continuing Participant
Measurement Periods
November – April
Admin Periods
May – June
Stability Periods
January 1 – June 30
July 1 – December 31
| Year 1 | Year 2 | ||||||||||||||||||||||||
| Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec | Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec | ||
| Measurement (cont'd) | Measurement Period | Measurement Period | Measurement Period | Meas. | |||||||||||||||||||||
| Admin | Admin | Admin | Admin | ||||||||||||||||||||||
| Stability Period | Stability Period | Stability Period | Stability Period | ||||||||||||||||||||||
| Year 1 | Year 2 | ||||||||||||||||||||||||
| Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec | Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec | ||
| Measurement (cont'd) | Measurement Period | Measurement Period | Measurement Period | Meas. | |||||||||||||||||||||
| Admin | Admin | Admin | Admin | ||||||||||||||||||||||
| Stability Period | Stability Period | Stability Period | Stability Period | ||||||||||||||||||||||
| Year 1 | Year 2 | ||||||||||||||||||||||||
| Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec | Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec | ||
| Measurement (cont'd) | Measurement Period | Measurement Period | Measurement Period | Meas. | |||||||||||||||||||||
| Admin | Admin | Admin | Admin | ||||||||||||||||||||||
| Stability Period | Stability Period | Stability Period | Stability Period | ||||||||||||||||||||||
Eligibility Example 1
| Year 1 | Year 2 | ||||||||||||||||||||||||
| Month | Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec | Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec | |
| Measurement | Measurement Period | Measurement Period | Measurement Period | Meas. | |||||||||||||||||||||
| IEP | Initial Employment Period | ||||||||||||||||||||||||
| Hours | 130 | 110 | 100 | 120 | 150 | 130 | 160 | 140 | 110 | 150 | 130 | 130 | 120 | 140 | 140 | 130 | 130 | 150 | 130 | 130 | 140 | 120 | |||
| Coverage |
Waiting Period |
Insured | |||||||||||||||||||||||
| Stability | Stability Period | Stability Period | |||||||||||||||||||||||
Eligibility Example 1
| Year 1 | Year 2 | ||||||||||||||||||||||||
| Month | Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec | Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec | |
| Measurement | Measurement Period | Measurement Period | Measurement Period | Meas. | |||||||||||||||||||||
| IEP | Initial Employment Period | ||||||||||||||||||||||||
| Hours | 130 | 110 | 100 | 120 | 150 | 130 | 160 | 140 | 110 | 150 | 130 | 130 | 120 | 140 | 140 | 130 | 130 | 150 | 130 | 130 | 140 | 120 | |||
| Coverage |
Waiting Period |
Insured | |||||||||||||||||||||||
| Stability | Stability Period | Stability Period | |||||||||||||||||||||||
Eligibility Example 1
| Year 1 | Year 2 | ||||||||||||||||||||||||
| Month | Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec | Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec | |
| Measurement | Measurement Period | Measurement Period | Measurement Period | Meas. | |||||||||||||||||||||
| IEP | Initial Employment Period | ||||||||||||||||||||||||
| Hours | 130 | 110 | 100 | 120 | 150 | 130 | 160 | 140 | 110 | 150 | 130 | 130 | 120 | 140 | 140 | 130 | 130 | 150 | 130 | 130 | 140 | 120 | |||
| Coverage |
Waiting Period |
Insured | |||||||||||||||||||||||
| Stability | Stability Period | Stability Period | |||||||||||||||||||||||
You enter Open Health on March 1 and report 130 hours in March while working for participating member employers. You become eligible for coverage after a two-month waiting period. During the waiting period you will receive Plan enrollment information. Your insurance coverage will begin June 1.
Your Initial Employment Period begins when you enter Open Health and extends to include a full Measurement Period and the following Admin Period. In this example your Initial Employment Period begins March 1 and ends December 31.
If you average at least 30 hours per week during the Measurement Period, you are eligible for coverage during the next six-month Stability Period.
(NOTE: you do not have to be reporting hours into the Plan during the Stability Period to remain insured although you may not become eligible for coverage during the subsequent Stability Period.)
Eligibility Example 2
| Year 1 | Year 2 | ||||||||||||||||||||||||
| Month | Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec | Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec | |
| Measurement | Measurement Period | Measurement Period | Measurement Period | Meas. | |||||||||||||||||||||
| IEP | Initial Employment Period | ||||||||||||||||||||||||
| Hours | 130 | 50 | 60 | 0 | 0 | 105 | 30 | 110 | 120 | 120 | 135 | 146 | 120 | 145 | 110 | 100 | 50 | 0 | 0 | 0 | 115 | 120 | |||
| Coverage |
Waiting Period |
Insured | Insured |
Admin Period |
Insured | ||||||||||||||||||||
| Stability | Stability Period | Stability Period | |||||||||||||||||||||||
Eligibility Example 2
| Year 1 | Year 2 | ||||||||||||||||||||||||
| Month | Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec | Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec | |
| Measurement | Measurement Period | Measurement Period | Measurement Period | Meas. | |||||||||||||||||||||
| IEP | Initial Employment Period | ||||||||||||||||||||||||
| Hours | 130 | 50 | 60 | 0 | 0 | 105 | 30 | 110 | 120 | 120 | 135 | 146 | 120 | 145 | 110 | 100 | 50 | 0 | 0 | 0 | 115 | 120 | |||
| Coverage |
Waiting Period |
Insured | Insured |
Admin Period |
Insured | ||||||||||||||||||||
| Stability | Stability Period | Stability Period | |||||||||||||||||||||||
Eligibility Example 2
| Year 1 | Year 2 | ||||||||||||||||||||||||
| Month | Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec | Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec | |
| Measurement | Measurement Period | Measurement Period | Measurement Period | Meas. | |||||||||||||||||||||
| IEP | Initial Employment Period | ||||||||||||||||||||||||
| Hours | 130 | 50 | 60 | 0 | 0 | 105 | 30 | 110 | 120 | 120 | 135 | 146 | 120 | 145 | 110 | 100 | 50 | 0 | 0 | 0 | 115 | 120 | |||
| Coverage |
Waiting Period |
Insured | Insured |
Admin Period |
Insured | ||||||||||||||||||||
| Stability | Stability Period | Stability Period | |||||||||||||||||||||||
You enter Open Health on March 1 and report 130 hours in March while working for participating member employers. You become eligible for coverage after a two-month waiting period, and your insurance coverage begins June 1.
You have no hours reported for 9 consecutive weeks (during June and July); therefore, your coverage ends July 31. You report hours in August and therefore regain coverage September 1 and remain insured until such time a Measurement Period can determine coverage for the next Stability Period. In this example, you averaged fewer than 30 hours per week during your first Measurement Period (May through October), so coverage ends December 31.
Eligibility Example 3
| Year 1 | Year 2 | ||||||||||||||||||||||||
| Month | Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec | Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec | |
| Measurement | Measurement Period | Measurement Period | Meas. | ||||||||||||||||||||||
| IEP | Initial Employment Period | Initial Employment Period | |||||||||||||||||||||||
| Hours | 110 | 130 | 100 | 120 | 150 | 130 | 160 | 140 | 110 | 150 | 130 | 130 | 0 | 0 | 0 | 0 | 0 | 100 | 105 | 115 | 110 | 130 | |||
| Coverage |
Waiting Period |
Insured | |||||||||||||||||||||||
| Stability | Stability Period | ||||||||||||||||||||||||
Eligibility Example 3
| Year 1 | Year 2 | ||||||||||||||||||||||||
| Month | Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec | Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec | |
| Measurement | Measurement Period | Measurement Period | Meas. | ||||||||||||||||||||||
| IEP | Initial Employment Period | Initial Employment Period | |||||||||||||||||||||||
| Hours | 110 | 130 | 100 | 120 | 150 | 130 | 160 | 140 | 110 | 150 | 130 | 130 | 0 | 0 | 0 | 0 | 0 | 100 | 105 | 115 | 110 | 130 | |||
| Coverage |
Waiting Period |
Insured | |||||||||||||||||||||||
| Stability | Stability Period | ||||||||||||||||||||||||
Eligibility Example 3
| Year 1 | Year 2 | ||||||||||||||||||||||||
| Month | Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec | Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec | |
| Measurement | Measurement Period | Measurement Period | Meas. | ||||||||||||||||||||||
| IEP | Initial Employment Period | Initial Employment Period | |||||||||||||||||||||||
| Hours | 110 | 130 | 100 | 120 | 150 | 130 | 160 | 140 | 110 | 150 | 130 | 130 | 0 | 0 | 0 | 0 | 0 | 100 | 105 | 115 | 110 | 130 | |||
| Coverage |
Waiting Period |
Insured | |||||||||||||||||||||||
| Stability | Stability Period | ||||||||||||||||||||||||
You enter Open Health on March 1 and report 130 hours in April while working for participating member employers. You become eligible for coverage after a two-month waiting period, and your insurance coverage begins July 1. You averaged 30+ hours per week during your first Measurement Period (May through October), so coverage continues through the first Stability Period (January through June).
You then averaged fewer than 30 hours per week during your second Measurement Period; thus, coverage ends at the end of your first Stability Period (June 30).
From March to July in Year 2 you have 22 weeks of inactivity. As such, when you begin to report hours again to the Plan you begin a new Initial Employment Period.