Qualifying Events
 

For Plan Year 2015
The Qualifying Event Period for 2015 is September 1, 2013 - August 31, 2014

A Qualifying Event is a specific course of action to be completed by a Member to determine which “YourChoice” Health Plan each Member is enrolled in for the Plan Year until the next Qualifying Event period.

 



Qualifying Guidelines for Adults

  • All dependents age 19 and older
  • The Qualifying Event Period is between September 1 and August 31
  • The Plan Year is January 1 through December 31
  • Qualifying is based upon age according to Evidence Based Guidelines and may be adjusted annually. For more information, refer to your annual qualifying events packet or download the forms below.
  • Tobacco Users must complete qualifying criteria each year  Read more...
  • Diabetics must complete qualifying criteria each year  Read more...

 Frequently Asked Questions     Qualifying Event Guidelines and Incentives


Adult Qualifying Events

ULTIMATE PLAN

 BEST PLAN

BETTER PLAN

BASIC PLAN

  • No qualifying events are required
     

Click Here for

Qualifying Event Forms

 

 



Qualifying Guidelines for Children

  • All dependents age 18 and under must complete the child qualifying events criteria each year to qualify for the Ultimate Plan.
  • All children are eligible for the ULTIMATE or BETTER Plans only

Child Qualifying Events

ULTIMATE PLAN

  • Child Wellness Exam, includes immunizations as required by Federal/State Statute
  • Annual Preventive Care Dental Exam and Cleaning

BETTER PLAN

  • No qualifying events are required

 

Click Here for Qualifying Event Forms

 

 



Qualifying Guidelines for NEW Enrollees


“YourChoice” BETTER Health Plan for Adults & Children
- 6 Month Probation Period

  • All new employees, spouses, and dependents enrolled in the plan will automatically be placed in the BETTER Plan for a 6 month period following their Benefits Effective Date:  no qualifying events are required.
 
“YourChoice” BETTER , BEST or Ultimate Health Plan - Upgrade


  • After a 6-month probationary period all new employees, enrolled spouses, and enrolled dependents are eligible to remain in the BETTER Plan*, or to upgrade to the BEST or ULTIMATE Plan by completing the applicable Qualifying Events listed above. *Children age 18 and under will remain in the BETTER Plan if the ULTIMATE Plan Qualifying Events are not completed as they are not eligible for the BASIC or BEST Plan Levels.
  • New employees, spouses, and dependents age 19 and over not completing the BETTER, BEST or ULTIMATE Plan qualifying events are automatically placed in the BASIC Plan until the next Qualifying Event Period.
  • The Qualifying Events and New Enrollee Worksheets must be completed and submitted within 90 days of the Benefits Effective Date.  No Exceptions.
  • New Enrollees complete screeinings and qualifying events according to their age on their Benefits Effective Date.  That is Dependents age 18 and under on their Benefits Effective Date complete the Child Qualifying Events. Dependents age 19 and over on their Benefits Effective Date complete the Adult Qualifying Events. 
  • The new Benefits Effective Date for the elected Plan is the 1st day of the 7th month from the original Benefits Effective Date.

 New Member Benefit Enrollment     

 New Enrollees Health Plan Eligibility Schedule  2012/2013    2013/2014

 QE Qualifying Event Instructions

 Work Site Lab Draw Schedule

 New Enrollee Nicotine Users-Health Plan Upgrade Options

 New Enrollee Tobacco Cessation Orientation Schedule

 yweight-iconYweight Health Bucks Program-Enrollment Instructions

 

 

 

 
RocketTheme Joomla Templates