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Qualifying Criteria

How do I qualify for coverage as a project-based employee?

Qualifying
Criteria

How do I qualify for coverage as a project-based employee?

Quaulifying Criteria

How do I qualify for coverage as a project-based employee?

There are two ways to qualify for health insurance coverage as
a project-based employee under Open Health :

Qualifying as a New Participant

Work 130+ hours in a calendar month
Coverage begins the first of the month following a 2 month Waiting Period

Qualifying as a New Participant


Work 130+ hours in
a calendar month
Coverage begins the first of the month following a 2 month Waiting Period

Qualifying as a
New Participant

Work 130+ hours in
a calendar month
Coverage begins the first of the month following a 2 month Waiting Period

Qualifying as a Continuing Participant

Work an average of 30+ hours per week during the Measurement Period
Coverage continues through the 6 – month Stability Period

Qualifying as a Continuing Participant

Work an average of 30+ hours per week during the Measurement Period
Coverage continuues through the 6 – month Stability Period

Qualifying as a
Continuing Participant

Work an average of 30+ hours per week during the Measurement Period
Coverage continuues through the 6 – month Stability Period

Measurement Periods

May – October
November – April

Admin Periods

November – December
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.

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