How It Works
Employee Eligibility
All staffing and temporary employees may enroll. There is no waiting period for the Essential StaffCARE program. New employees are eligible to enroll on day one.
Dependents Dependents are eligible to enroll in all plans except the short-term disability plan. Dependents include an employee’s spouse and unmarried children - natural, adopted or step-children up to age 19 (or age 25 if a full-time student).
Group Requirements Your group must have a minimum of 100 eligible employees to qualify for the plan. (Some exceptions can be made.) There is no minimum participation requirement.
Employer Contribution Employer contributions are not required. However, you may choose to contribute part or all of the premium for any or all of the benefit plan choices, including medical/prescription, vision care, dental plan, and the other ancillary products.
Employee Coverage Premium payments are handled through weekly payroll deductions. Employers must be able to send PAI a weekly payroll feed to track eligibility. PAI will send the employer a weekly deduction file in either electronic or hard copy format. Employee’s coverage begins the first Monday after the first deductions are taken. If an employee misses a payroll deduction, any time after the first one, and does not make it up with a missed premium payment, the employee will have a gap in coverage during that pay period. Claims that occur during periods of non-payment will not be paid. |
An employee may make up a missed premium by paying it directly to PAI. The employee can enjoy continuous coverage by mailing full payment within 45 days after the date on the paycheck from which the deduction would have been taken. If a missed premium is overdue by more than 45 days, it cannot be made up.
Coverage may not be continued by direct payments for more than six consecutive weeks. At that time, coverage will terminate and the employee will have to wait until the next Open Enrollment Period to re-enroll. Enrollment Open Enrollment - During the Open Enrollment Period, employees may enroll by completing a simple, easy to understand enrollment form, or through an IVR or Web-based enrollment system. This enrollment period occurs once a year. With the exception of new hires, open enrollment is the only time for employees to enter the plan. It is also the time for employees previously covered under the plan to re-enter. Family Status Changes - In the event an eligible employee loses other healthcare coverage or has a change in family status, including marriage, divorce, legal separation, death of a spouse, and birth or adoption of a dependent, the employee may enroll for or change coverage through a special enrollment. Valid proof of the family status change or loss of coverage must be provided. Pre-Existing Conditions If an employee has a pre-existing condition, which includes anything for which medical advice or treatment was received within the six-month period before the coverage begins, the employee must wait twelve months before being covered for that condition. This does not apply to pregnancy and to newly born or adopted children under the age of 18 who have been added to the policy within 31 days of birth or adoption. If the employee submits a letter of creditable coverage from a previous insurer, the pre-existing condition waiting period may be reduced or eliminated. |
