Online Insurance Continuing Education - Eligibility for Coverage
Online Insurance Continuing Education - Eligibility for Coverage
ELIGIBILITY FOR COVERAGE
A unique provision of Group insurance is the requirement of eligibility. Most Group insurance is not subject to individual medical conditions so certain provisions such as Eligibility is a method of underwriting.
Please note that some of the eligibility requirements may not apply in some jurisdictions because of recent legislation. The purpose of this provision is to justify the premiums by ensuring that the employee falls within the requirements.
The following individuals only are eligible to apply for coverage under this Contract. YOUR INSURANCE COMPANY may require acceptable documentation that an individual meets and continues to meet the eligibility requirements (e.g., court order naming the Certificateholder as the legal guardian or Adoption documentation).
Bona fide employees of the Contractholder who meet each of the following requirements are eligible to apply for coverage under this Contract:
1. the employee's job must fall within a job classification set forth on the Group Application;
2. the employee must be scheduled to work and actually work on a fulltime basis at least 25
hours or more each week. Parttime, temporary or substitute employees are not eligible;
3. the employee must be actively at work on the Effective Date of coverage; and
4. the employee must have completed any applicable Waiting Period set forth on the Group
Application.
The Certificateholder eligibility classification may be modified, and may be expanded to include:
1. retired employees;
2. additional job classifications;
3. employees of affiliated or subsidiary companies of the Contractholder, provided such companies and the Contractholder are under common control; and
4. other individuals as determined by YOUR INSURANCE COMPANY (e.g., members of associations or labor unions).
Any expansion of the Certificateholder eligibility class must be approved in writing by YOUR INSURANCE COMPANY and the Contractholder prior to such expansion, and may be subject to different Rates.
The following individuals are eligible to apply for coverage under this Contract:
1. the Certificateholder's present lawful spouse; and/or
2. the Certificateholder's unmarried natural, newborn, Adopted, Foster, or stepchild(ren), or a child for whom the Certificateholder has been court appointed as legal guardian or legal custodian, who is under the limiting age.
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