Eligible Employee: An active full-time employee, including an owner, sole proprietor or partner who works a minimum of 30 hours on average per week for the Policyholder and has completed any probationary period for employees and for whom the Policyholder deducts FICA taxes from your pay.
The following are eligible as a dependent:
- The legal spouse of an enrolled employee
- Dependent child who is:
- Less than 19 years of age, whose principle residence is with the subscriber (unless the dependent resides with the other spouse according to a qualified medical child support order.)
- Is primarily dependent upon the subscriber or the subscriber’s spouse for support and maintenance
- Is claimed as a dependent on the subscriber’s or the subscriber’s spouse’s income tax return
- Any stepchild, legally adopted or child placed in the subscriber’s home prior to adoption, or a child for whom the subscriber is legal guardian
- Any unmarried dependent child who is incapable of self-support and became so incapacitated before attaining age 19. To be eligible as an incapacitated dependent child, the dependent child must have been covered under this plan or a plan it replaces prior to reaching age 19.
- For which you are ordered to provide coverage through a Qualified Child Support Order
- An unmarried dependent child between 19-25 who is enrolled full time (12 credit hours per semester) at a Post Secondary Educational Institution for at least five months out of the calendar year
Note: Any employee enrolling a student must provide an original student status letter from the registrar’s office of an accredited school stating their son/daughter is a full-time student. (A student’s schedule or receipt for payment is not acceptable verification of student-status).
HPS verifies student status twice annually, once in January and again in August. It is the responsibility of the subscriber to ensure that this information is requested and forwarded to HPS. Claims will be denied until this information is received. If a child ceases to be an eligible dependent, notification must be sent in writing to remove them. Premium changes will not take effect until this is done.
Newborns are automatically covered for thirty-one (31) days after birth. To continue coverage beyond thirty-one 31 days, (unless the subscriber is already enrolled under the family membership plan), the subscriber must apply for coverage for the newborn by submitting an enrollment/change form to the Policyholder within the thirty-one (31) day period. Any subscriber who is already enrolled under the family membership plan must complete an enrollment/change form to provide information about the newborn to Health Plan Select. Premium increases, if applicable, will be effective from the date of birth.
The following dependents are not eligible to enroll for coverage:
- Parents
- Married Children
- A child or spouse on active duty in the armed forces of any country except for temporary duty of 31 days or less.
- Children who are past the plan’s maximum age provisions (unless physically or mentally disabled)
- Grandchildren and stepchildren (unless they meet eligibility requirements previously described);
- Sister or brothers (unless Subscriber is appointed the legal guardian by the court and may claim the sibling as a dependent on their federal income tax return and all other eligibility requirements are met).
- Step Children who do not live with the subscriber unless ordered to do so by through a Qualified Child Support Order (QMCSO).
Medicare: Employees are not eligible for coverage under Medicare by reason of age unless Medicare guidelines allow your employee to be coverage and they have specifically requested that Health Plan Select be their primary coverage.
