Eligible Employees

Full-Time

Employees should be working on a permanent as well as full-time basis and must have a normal work schedule of maximum 30 hours per week. They must be compensated for that work by the employer (subject to withholding appearing on a W-2 form).

Part-Time

Employees must be employed on a permanent as well as part-time basis and will have a normal work schedule of at least 20 hours, but not more than 29 hours per week. They must be compensated for that work by the employer additionally(subject to withholding appearing on a W-2 form).

NOTE: It is the employer's option to provide health coverage to part-time employees. If that alternative is worked out, all sited individuals must be offered coverage under the employer's benefit plan in the same way.

Sole Proprietors/Partners/Corporate Officers

Sole proprietors, partners, and corporate officers must work at least 20 hours per week. However, disqualified employees temporary, seasonal workers and persons who got remuneration on a 1099 basis are ineligible to enroll in a Blue Cross Small Group plan.

Cal-COBRA, COBRA-, FMLA-Eligible Groups

Employers who have the capability for attaining coverage under Cal-COBRA (California law SB719), COBRA (Federal Omnibus Budget Reconciliation Act) or FMLA (Family and Medical Leave Act) should terminate a questionnaire, smudging out that the qualifying event as well as the date continuation coverage began at the same time.

Eligible Dependents

An eligible dependent has one of the following relationships with an eligible employee:

Effective Date

The date coverage takes effect for a group must be the first or fifteenth of a month.

Employer Waiting Periods

There may be an exact period that they must be employed, known as an employer waiting period, before their dependents become eligible for group coverage and after employees are hired. The employee's eligibility date is the first of the month and after the waiting period ends. Employers may also choose a waiting period of the first of the month by following an employee's date of hire, or one, two, three, four, five to six months of employment before getting eligible for benefits.

Spouses

A husband and wife employed at the same company may both be covered as employees. Children may be considered the dependents of either one or both of the employees.

Adding Employees and Dependents

New employees and dependents must propose completed applications to Blue Cross within 30 days of becoming eligible for coverage. Not later on than the last day of the month prior to the requested effective date, applications must be received. Declining Coverage

Employees who choose not to participate in a group's health plan must decline coverage by completing Sections 2 and 4 of the Small Group Employee Application within 30 days of becoming eligible.

Late Enrollment

Employees and dependents eligible for coverage that choose to enroll at a later date may be considered late enrollees and they will be subject to a 12-month waiting period from the date they apply for.

Waiting Period for Preexisting Conditions

A preexisting condition is an illness, disease or physical condition for which medical advice, diagnosis, care or treatment was recommended or received from a licensed health practitioner during the six months before the effective date of coverage or the first day of the waiting period, whichever is earlier. If an employee or dependent applies for coverage within 62 days of terminating membership in an individual health care plan, or within 180 days of terminating coverage in a group health care plan, or within 180 days of terminating coverage in a group health care plan, Blue Cross will credit the time enrolled in the previous plan toward the preexisting condition waiting period.

Term of Coverage

Coverage remains in force as long as the group pays the required premium on time and remains eligible for membership. Coverage will cease if the group becomes ineligible for reasons including, but not limited to, the following:

Employer Contributions

Employers must contribute at least 50 percent (60 percent for Employee Elect) of the employee's medical and dental premiums and 25 percent of the employee's life premium. The employer is not required to contribute to the cost of dependents' coverage.

Employee Participation

At least 75 percent of eligible employees must enroll suppose if an employee contributes to the medical as well as dental premium. If so, then each and every eligible employee ought to enroll. An employee who refuses coverage as he or she may be covered by a spouse's employer's group medical together with dental plans that get excluded in determining participation.

Out-of-State Employees

The majority of enrolling employees (51percent) must be employed within the state of California. Residents of Hawaii are not eligible.

Rate Guarantees

Medical rates may be assured for six or twelve months. During the guarantee period, the rating formula for the group will not get altered. Beyond the guarantee period, Blue Cross reserves the right to change rates, change coverage or amend the group's contract with 30 days' notice as permitted by law. A group member's rate may be accustomed at any time for the reason that modifications occurred in the following:

Changes in Coverage

A group may demand a coverage, plan or benefit change once in a 12-month period. Requests for changes that should be made in exposure must be received 30 days prior to the requested effective date, and these requests are subject to underwriting review.

Definite change requests can become very effective on the group's anniversary date and may be focused for underwriting review that includes the following:

NOTE: A benefit modification does not initiate a new rate guarantee period.

Workers’ Compensation

Submit the items listed below to Fremont Compensation Insurance Company at the following fax number: 1-805-499-7214 for acquiring a Worker's Compensation quote.

And to recognize Fremont's quote for Workers' Compensation coverage, submit a company check for the required deposit premium listed on Fremont's quote cover letter to the following address:

Fremont Compensation Insurance Company
P.O. Box 9057
Oxnard, CA 93031