Insurance Benefits

Eligibility

Employees hired to work an average of thirty (30) hours per week or more are eligible for insurance benefits including medical, dental, vision, short-term disability, accident insurance, basic life, and voluntary life. Salaried employees meeting this status also are eligible for long-term disability insurance.

Enrollment is explained in the graphic below:

1. Medical Coverage:
   1. Any employee who is not regularly scheduled a minimum of 30 hours or more a week, may be eligible for medical coverage only if they average 30+ hours a week during a twelve month measurement period as required by the Affordable Care Act. A variable hour employee is an employee who is not regularly scheduled to work 30 hours or more per week. If the variable hour employee works a minimum of 30 hours during a twelve month measurement period, insurance will be offered effective the first of the month after a full month’s administrative period and the insurance, if chosen would be effective for a minimum of a twelve month stability period. This is explained in the graphic below.
   2. Limitations: Employees in participant directed services that are classified as joint employees are eligible for medical insurance benefits only if eligibility requirements are met. Employees in this group have set hours and are not treated as variable hour employees unless indicated by their Manager.

Enrollment

The eligible employee receives information on the insurance plans after attaining eligibility. Enrollment elections must be made through Colonial Life during the enrollment period listed in the information packet. Failure to enroll through Colonial Life during the enrollment period results in the employee voluntarily declining coverage.

Once the initial enrollment period has passed, the employee is not eligible to reapply for coverage until the designated annual open enrollment. Open enrollment for all benefits is in November/December with effective coverage January 1^st, or for variable hour workers, after meeting the hour requirement after a measurement period. If you are newly hired during the year or have a status change that makes you eligible enrollment will be the first of the month following 60 days of employment with your qualifying status. During open enrollment, any eligible employee can apply for coverage, or add dependents to their coverage.

Dependents may be added or dropped from your insurance policy at the time of marriage, birth or adoption. Other qualifying events may allow an employee or dependents to enter the plan.

Enrollment in the Mains’l paid life insurance and long term disability plan is mandatory for all eligible employees. All employees will be enrolled. There is not an open enrollment for the Mains’l paid life and disability insurance.

Cost of Coverage

The exact amount of the employee contribution for the insurance is provided to employees with the enrollment information. The employee contribution for coverage is deducted from payroll. Employees acknowledge payroll deductions verbally and with an electronic signature through Colonial Life during enrollment.

The cost for the medical insurance depends on the coverage elected. For employee only, the cost is based on the age band of the employee. If electing spousal coverage, the cost for the spouse is based on the age of the spouse. Also, if electing coverage for children, the cost is based on number of children enrolled in the coverage.

The cost for the dental insurance depends on the coverage elected – employee only or family.

The cost for the vision insurance depends on the coverage elected – employee only, employee plus spouse, employee plus child (ren) or family.

The cost for voluntary short term disability insurance depends on the coverage elected and is age based. Coverage can be elected for legal dependents.

The cost for voluntary accident insurance depends on the coverage elected – employee, employee plus spouse, one parent family, or two parent families.                                                                                                                      

The cost for voluntary life insurance depends on the coverage elected and is age based. Coverage can be elected for legal dependents.

The cost for the mandatory life insurance and long term disability insurance (employee coverage is available) is paid by Mains’l

Please note that in order to enroll any spouse or children where coverages are available, the employee themselves must be enrolled in the coverage.

Ineligibility and Termination of Coverage

The federal Consolidated Omnibus Budget Reconciliation Act (COBRA) and state law gives employees and their qualified beneficiaries the opportunity to continue health, dental, vision and life insurance coverage under the Mains’l sponsored plan when a “qualifying event” would normally result in the loss of eligibility. Typical qualifying events include resignation, separation of employment, or death of an employee; a reduction in an employee’s hours or a leave of absence; an employee’s divorce or legal separation; and a dependent child no longer meeting eligibility requirements.

If the employee is still employed, but is no longer eligible due to reduction of hours, the following will occur:

1. Employees that are regularly scheduled 30+ hours a week who voluntarily reduce to part-time status (<30 hours a week), benefits will continue until the last day of the month of the status change.
2. Employees that are regularly scheduled 30+ hours a week that involuntarily have their schedule reduced due to changes in business needs will be given thirty days to find a position in the agency that allows them to keep their status. If a position isn’t found after thirty days, benefits will continue until the last day of the month after the thirty day mark.
3. Variable hour part-time employees that met the 30 hours a week average through a measurement period will be sent a notice prior to termination that they will have one month to obtain regularly scheduled hours for at least 30+ hours a week if they would like to maintain medical insurance. Failure to find additional hours in the time frame will result in loss of coverage on the last day of the month following the notice.

If coverage is cancelled, the employee will be offered continuation of insurance through COBRA. Under COBRA, the employee or beneficiary pays the full cost of coverage at Mains’l group rates plus an administration fee. Mains’l provides each eligible employee with a written notice describing rights granted under COBRA and state law when the employee becomes eligible for COBRA continuation coverage. Contact the human resources department for additional information.