Employee Eligibility

Standard Open Enrollment Period

For all ongoing employees, the standard open enrollment period is October 15 - November 15 each year with a 60-day administration period. The eligibility of any ongoing full-time employee should be determined during the annual open enrollment period. If the employee is qualified, he or she should be enrolled in your plan during the 60-day administrative period.

Coverage for all ongoing employees becomes effective January 1 of each year.

Qualifying event special enrollment period

In order to qualify for medical coverage during a special enrollment period, an applicant needs to have a qualifying event. Click here to learn about qualifying events and the documentation that is required to be submitted with the application. PLEASE NOTE APPLICATIONS MUST BE SUBMITTED WITHIN 60 DAYS OF THE QUALIFYING EVENT.

Information on employee types

A newly eligible employee is considered either a full-time or a variable-hourly employee. Below are the eligibility details for each employee type.

New Full-Time Employee:

A new employee who is considered a full-time employee and is eligible for enrollment in your benefits plan if he or she is reasonably expected to work, on average, the employer’s specified full-time hours when hired.

The new full-time employee is eligible for coverage upon satisfying the employer’s established benefit waiting period, must be enrolled within the 60-day administrative period immediately following.

Each dental office will specify both its full-time hours requirement and its employee benefit probationary period on the ODA Wellness Trust Enrollment Contracts or Annual Office Census. Per ACA for health benefits, full-time must be at least 25 hours and not more than 30 hours weekly.  The benefit probationary period cannot be longer than 90 days.

New Variable Hourly Employee:

A new employee is considered a variable-hourly employee if, at the employee’s hire date, it cannot be determined that the employee is reasonably expected to work, on average, the employer’s specified full-time hours each week.

Simply put, if an employee works fewer than 25 hours per week, he or she is considered part-time and is not eligible for benefits.

The next qualifying period for determining an employee’s full-time status for a new variable-hourly employee would be either the next standard open enrollment period (October 15 through November 15) or at the one year anniversary, whichever comes first.

Ongoing Employees:

An employee, whether full-time or variable hourly, is classified as an ongoing employee if he or she has been employed through one standard Open Enrollment period.


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