Employee Eligibility Criteria

For an individual employee to be eligible to participate in HealthShare, he or she must meet the following criteria both at the time of application and, except as specified otherwise below, throughout the entire period of participation:

• Be an active, paid employee working an average of 15.5 hours per week, to whom the employer issues a W-2, and not an independent contractor, temporary worker, seasonal or retiree.
• Have been continuously and actively employed as an employee for the duration of time set forth by the employer as the initial wait period (cannot exceed 13 weeks)
• be ineligible to participate in, either directly or as a dependent, or to otherwise receive health benefits under, any type of federal, state or business-sponsored ongoing health insurance, health benefit plan or program of health benefits, including but not limited to Medicare, Medical Assistance, Veterans Benefits, Native American Health Care or any ongoing employer or association-sponsored health benefit program
• Employees may not cancel coverage to enroll in HealthShare unless the current policy is a COBRA Continuation policy or a Major Medical/Catastrophic policy.

HealthShare may formally review employees' eligibility for continued program participation at least annually. The employee must notify HealthShare immediately upon discovering that he/she fails to meet any of the eligibility criteria.

If the employee becomes ineligible for HealthShare due to change in employment status, the enrolled dependents are no longer eligible.

Special Circumstances

• Pregnancy is only a covered benefit with HealthShare if the employee is not eligible for Medical Assistance or other public programs. HealthShare staff will screen for Medical Assistance and other program eligibility and facilitate enrollment.
• Medicare-eligible employees are not eligible for HealthShare; this includes Medicare for a disability, upon turning age 65, and/or ESRD (End Stage Renal Disease).
• If the employee becomes ineligible for HealthShare due to change in employment status, the enrolled dependents are no longer eligible.