Benefits Eligibility

Eligibility Overview

Health plans are put together carefully to provide the best benefits possible for participants. ASBAIT and Meritain Health know how important it is for health care consumers like you to really understand how your plan works. In this way, you can make the changes you want in your health and in your life. The next section of this packet describes some of the most important provisions of your benefits. It’s another way we’re working with you to help you get the most from your benefits—so you can live a life that’s balanced and informed, with no surprises.

Special Enrollment

In some situations during the year or after open enrollment, you may be able to add, delete or change your benefit choices.

Involuntary loss of other benefits.
Change in marital status.
Death of covered spouse or dependent.
Birth.
Adoption.
Placement of a child in your home for adoption.

Refer to the Summary Plan Description (SPD) for a full description of special enrollment.

Family Coverage

Your family members can also reap the rewards of the plan. Health care benefits are available for every eligible dependent. It’s a great way to help your family members find the right balance between life’s “roller-coaster ride” and their best health. Be sure your family knows about the opportunities open to them—share this packet and other materials you receive from the plan!

Eligible Dependents

This benefit plan is open to you and your eligible dependents. An eligible dependent is:

Your spouse (as defined in your plan documents).
Your children, natural or adopted.
Stepchildren.
A domestic partner that is living in your home (could vary by district).
Children who have been placed with you for adoption.
Children for whom you are the legal guardian.

ACA note: Dependent coverage is available for any child (regardless of marital status, residency, student status, etc.) of an employee who is deemed to be the employee’s biological, step, foster or adopted child (including a child placed for adoption) until the end of the month in which such child reaches age 26.

Other Coverage

If a family member is covered by a different plan:

You can enroll yourself and your eligible dependents in this plan.
You can enroll yourself in this plan, but decline benefits for some or all dependent(s).
You can decline benefits for your whole family.

Dependent Changes

Tell your employer if:

You become divorced or are legally separated from a spouse who was covered under this plan.
A dependent child ceases to meet the eligibility terms of the plan.

COBRA Deadline: To enroll the dependent for COBRA—a special limited-time plan for continuing benefits at your own expense—you must notify your employer within 60 days of that person’s change in dependent status.

Coordination of Benefits

If you or one of your dependents have benefits under both this plan and another plan, the two plans will coordinate your benefits. One plan will be considered the primary plan (or first payer) and the other will be the secondary plan (pays only after the first plan has paid).

Generally, Meritain Health uses a birthday rule to decide which plan would be the primary plan.

Please refer to your SPD for specific requirements.

Declining Coverage

You can refuse the benefits of this plan, but be sure you’ve looked at the pluses and minuses of that decision.

Declining Coverage: If you don’t enroll now, you’ll have to wait for the next open enrollment period or until you qualify for special enrollment due to a qualifying event.

Open Enrollment

You and your eligible dependents may enroll for coverage during this time called Open Enrollment. Your school will communicate your dates of open enrollment.

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