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Las Vegas Group Health Insurance - Typical Ineligible
Categories
Associations, multiple employer trusts,
part-time and seasonal employees, retirees, and board of
director members and stockholders aren’t eligible for
coverage. These categories are defined or explained below:
a. Association (unless qualifying as a
guaranteed association): A group of employer units banded
together for any reason
b. Multiple employer trust (unless
qualifying as a guaranteed association): Employers, usually
in the same or related industries, brought together by an
insurer, agent, broker or administrator to provide insurance
for their employees under a master contract issued to a
trustee under a trust agreement
c. Part-time employee: In Nevada an employee
who works less than 30 hours per week
d. Seasonal employee: An employee who
regularly works less than 12 consecutive months but for
periods of time that are definite in length and with a
formal policy of recall
e. Retirees are eligible for Individual
conversion or Medicare Supplement products.
f. Board of director members and
stockholders aren’t eligible for coverage unless they’re
also officers of the company and working at least 30 hours
per week
Employer Contribution
Employers can choose how much they’ll
contribute to their employees’ health premiums based on the
options below. Payroll deduction is required if
the Las Vegas Insurance Plan is Considered Contributory.
a. Traditional option: The employer
contributes at least 50 percent of each covered employee’s
monthly health premium.
b. Fixed dollar option: (currently
only available
only through the Anthem Blue Cross EmployeeElect Program)
The
employer can contribute a fixed dollar amount of $125 or
more, in $5 increments, for each covered employee’s monthly
health premium.
Employee Eligibility
To be eligible as an employee, a person must
be an active full-time employee with a regularly scheduled
work week of at least 30 hours per week and compensated for
that work by the employer (subject to withholding it as
appears on a W-2 form). Sole proprietors, partners and
corporate officers must work at least 30 hours a week to be
eligible.
Employee
Participation Requirements
Most Nevada Group Insurers that actively
market PPO and HMO health plans, at least 75 percent of the
group’s eligible employees must participate. Groups must
maintain all of their minimum participation levels to remain
eligible (100 percent if non-contributory).
Nevada Group Carriers may not renew a group
if its participation falls below the required minimum. If an
employee waives coverage due to other group coverage through
another employer (as a subscriber or a dependent), because
the employee has an Individual policy, or because the
employee has other qualifying creditable coverage, the
employee may be ineligible for the purposes of calculating
participation. The employer must submit a declination for
these employees.
If a husband and wife both work for the same
employer, they can apply separately as employees, or one can
be covered as a dependent on the other’s policy. Their
children can apply as dependents of either or both
employees. The contract holder under a single contract will
be the employee whose date of birth falls first in the year.
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