Page 4 - Palomar EE Guide 01-19 FINAL

Eligibility

Eligibility / Waiting Period
For new hires, benefits are effective on the first of the month following 60 days of employment in a benefit-eligible classification. If you fail to
enroll within 31 days of your effective date, you will only receive the basic employer provided benefits of life and disability (if eligible). You
will not be eligible to enroll in the medical, dental, vision insurance plans and supplementary benefits until the next annual open enrollment
period.

Who Is Eligible
You are eligible for Palomar Health benefits if you are:
• A regular, full-time employee, scheduled to work at least 80 hours per pay period (72 hours per pay period if you work 12-hour shifts)
• A regular, part-time II employee, scheduled to work at least 60 hours per pay period
• A regular, part-time I employee, scheduled to work at least 36 hours per pay period

Your dependents* are also eligible to be covered under the Palomar Health insurance benefits if they are:
• Your spouse or domestic partner
• Your child(ren) up to age 26 (unless eligible for benefits with his/her own employer)
• A dependent child who is considered to be physically or mentally disabled

*Dependent verification documents are required for all dependents you are covering for the first time under your Palomar Health benefits. Documentation is
not required in subsequent years after initial documentation is established, unless specifically requested during a periodic dependent eligibility audit.

Changing Your Benefits
Once enrolled in health, dental, vision, flexible spending account plans or other pre-tax insurance plans, the benefits you choose will remain in
effect throughout the plan year (January 1 - December 31). You may not change your benefit elections, unless you have a life event.

A life event occurs if you:
• Get married, divorced, or legally separated
• Meet qualifications for domestic partnership
• Add a dependent child(ren) through birth, marriage, domestic partnership, legal adoption or placement in your home for adoption, or
change in custody
• Dependent dies
• Have a change in employment status that affects benefit coverage
• Change your employment status
(for example, from part-time I to part-time II or full time where disability benefits become available to you)
• Experience a loss or gain of other group health coverage
• Change from a Union to a non-Union position making you eligible for the medical plan or vise versa.
• Loss of coverage through Medicaid or Children’s Health Insurance Program (CHIP)
• Becoming eligible for a state’s premium assistance program under Medicaid or CHIP

Changes in benefit coverage must be related to a life event. Any coverage changes must be made within 31 days of the life event and will be
made effective on the date of event.

If you do not make coverage changes within 31 days (e.g. adding a child within 31 days of birth), you must wait until the next open enrollment
period with coverage going into effect January 1.

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