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Eligibility Guidelines

ELIGIBLE COMPANIES

To be eligible for coverage a company must:

  • Be actively in business
  • Enroll 1-9 eligible employees (owners included)
  • Contribute 50% of the Individual and 33%of the Family premium
  • Be located within the Fallon Health service area
  • Be a member in good standing of HSA

ELIGIBLE EMPLOYEES

An eligible employee is one who:

  • Works at least 20 hours per week for the employer
  • Was hired to work for a period not less than 5 months
  • Lives within the FCHP service area

NEW EMPLOYEES

  • All future eligible employees can be enrolled within 30 days of hire or within a time frame consistent with company new hire probation policy

WAIVER OF COVERAGE

Full Time employees can be excluded who are:

  • Covered by a spouse’s or parent’s health plan
  • Age 65 or over and covered by Medicare
  • Living outside the Fallon Health service area

PARTICIPATION REQUIREMENTS

Groups of 1-5

  • 100% of eligible employees must enroll

Groups of 6-9

  • At least 75% eligible employees must enroll

PLAN SELECTION

  • All employees must select the same plan

EFFECTIVE DATES

  • All coverage will be effective on the 1st day of the month, contingent upon the carrier’s enrollment requirements. Enrollment materials should be received by the 25th day of the preceding month.