Common use of Eligibility Guidelines Clause in Contracts

Eligibility Guidelines. A. Small Employer Eligibility To be considered an Eligible Small Employer to offer Healthy New York all of the following criteria must be met by the Group: B. Subscriber Eligibility‌ Eligible employees of the Group will be employees of the Group who work a minimum of 10[20 hours per week] who earn 11[$43,000 or less] annually 12[and part-time employees who work 13[20 hours or less per week].] In addition, eligible employees of the Group and their eligible family members will meet the eligibility criteria set forth in the Certificate and the requirements set forth below:‌‌‌‌‌‌ Subscribers: Subscribers will be eligible on the 14[first day of month] occurring 15[30 days] after commencement of employment. Coverage ends on the 16[last day of the month in which eligibility ends].‌‌‌‌ 17[Such waiting period is waived for employees rehired within 18[six] months after an approved leave of absence.]‌‌‌ Covered Dependents: The legal spouse of the Subscriber and any dependent children, as defined in the Certificate, are eligible for coverage. Such children are eligible only until the child reaches age [3326]. Coverage ends on the last day of the month in which child’s birthday occurs. Handicapped dependents: The attainment of the limiting age for dependent children shall not operate to terminate the coverage of the child if at such date the child is and continues thereafter to be both (1) incapable of self-sustaining employment by reason of mental or physical handicap and (2) chiefly dependent upon such employee or Subscriber for support and maintenance. Proof of the incapacity and dependency shall be furnished by the employee or Subscriber within thirty-one days of the child’s attainment of the limiting age. Periodic proof may be required, but in no case more frequently than once a year. Adopted children: Coverage shall be provided for children legally placed for adoption with an employee or other Subscriber of the Group who is an adoptive parent or prospective adoptive parent, even though the adoption has not been finalized, provided the child is dependent upon such employee or Subscriber for support and maintenance. The Group may require notification of the acceptance of the child within thirty-one days after the acceptance of such child in order to continue coverage. 19[Coverage for Dependents through age 29: A Dependent who has attained the above limiting age can continue coverage until they reach age 30 subject to the eligibility requirements outlined in the Certificate.] The eligibility requirements listed in this section of this Group Enrollment Agreement are material to Our administration of the Agreement. During the term of the Agreement, We will not permit any change in these eligibility requirements unless We agree, in writing, to such change.