Élan Eligibility
ELIGIBLE EMPLOYERS
- A minimum of 3 non-related full time employees must be enrolled. Maximum of 99 employees for the DeltaPreferred Option (DPO) Plan and the Medical Eye Services (MES) Vision Plan. Maximum of 149 employees for the DeltaCare (Dental HMO). For Employers with employees over the maximums stated above, refer to your General Agent or the Administrative Office for instructions.
- Sole Proprietors, Partnerships or Corporations that file appropriate government forms.
- Place of business must be other than a place of residency.
- Must have a bank account under company name.
ELIGIBLE EMPLOYEES:
- Full-time, working a minimum of 24 hours per week. If an employer’s group medical plan uses a different definition of a full-time employee, the same definition may be used for the dental plan. However, in matching the medical plan, the minimum numbers of hours must be at least 20 hours per week.
- An Employer/Employee relationship must exist.
- Husband & Spouse when employed by the same employer are each covered as employees. Children will be covered under the parent with the earlier birth date in the calendar year.
- Employees NOT eligible are: 1) Contract Workers, 2) Commission Sales People [1099], 3) Seasonal or Part-time Workers. Union employees covered under a collective bargaining agreement may be covered. Refer to your General Agent or the Administrative Office for instructions and guidelines.
Refer to the Industry Tables (also referred to as "SIC TABLES") in the brochure for classification of eligibility.
ELIGIBLE DEPENDENTS:
- The employee’s spouse, who is not legally separated and is not a member of the Armed Forces.
- The employee’s children (including step children, legally adopted children and foster children) who are declared as dependents on the employee’s federal income tax return, providing they are unmarried and under age 19 (extended to age 23 if a full-time student at an accredited institution of higher education).
- Dependents must be covered under the same plan of benefits as the employee.
PARTICIPATION RULES
The employer must pay 100% of the employee premium.
Dependent Participation
Option A – If the employer pays 50% or more of the dependent premium there is no percentage participation requirements.
Option B – If the employer contribution is 0% to 49% of the dependent premium, then 75% of the eligible dependents must enroll for coverage to be issued.
The employer may choose to cover employees only, however, if dependent coverage is elected to be added by the employer at a future date it may only be added on the employer anniversary date.
If an employee or dependent is covered under another “group” dental or vision plan and proof is submitted, they may waive out by completing a Refusal Form and are excluded in the calculation of participation requirements.
If a dependent refuses coverage for any other reason, they may NOT enroll at a future date.
Failure to enroll eligible employees could cause the employer to become ineligible to continue coverage with the trust. Also, the un-enrolled employee and any eligible dependents will NOT be allowed to enroll anytime in the future, without paying back premiums for a maximum of 12 months.