Eligibility Guidelines

Eligible Companies
Most employers are eligible to participate. A list of ineligible businesses is shown below. Firms in business less than two years, firms not participating in Social Security, and firms with employees residing on employer’s premises are also ineligible.

Eligible Employees
Eligible employees are those actively working full time for a minimum of 30 hours per week year round (non-seasonal) who have satisfied the employer’s minimum service requirement.

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

Participation Requirements

• 2 to 5 eligible employees – all must be insured
• 6 to 9 eligible employees – all but one must be insured
• 10 to 19 eligible employees – 75% must be insured

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

Contribution Levels
Employers must contribute at least 25% of premium. If the employer
pays 100% of the premium, all eligible employees must be insured.
 

Ineligible Businesses
The following types of groups are ineligible for the SmartChoice LTD Plan:

        SIC Code Industry Classification
         0111-0971 Agriculture, Forestry, Fishing, Hunting & Trapping
         1011-1241 Metal & Coal Mining
         1311-1499 Oil/Gas Extraction, Mining & Quarrying
         1611-1629 Heavy Construction
         1761-1799 Special Trade Contractors
         2111-2141 Tobacco Products
         2411-2431 Logging, Sawmills & Millwork
         2611-2631 Pulp/Paper Mills
         2892 Explosives
         3292 Asbestos
         3482-3489 Ordinance & Accessories
         4311 U.S. Postal Service
         4493 Marinas
         4612-4619 Pipelines
         4952-4959 Sewer/Refuse
         5541 Gasoline Service Stations
         5812-5813 Eating & Drinking Places
         5921 Liquor Stores
         5983-5989 Fuel Oil Dealers
         7011-7041 Hotels/Motels
         7381 Detective, Guard or Armored Services
         7911-7999 Amusement & Recreation Services
         8082 Home Health Care Services
         8811 Private Households
         8999 Services, Nec
         9221-9229 Public Safety
         9711-9999 National Security/International Affairs

NOTE: For SIC Code range of 8011-8099, Health Services, Doctors (including Anesthesiologists) and Dentists are ineligible for SmartChoice LTD coverage. The other employees of the Health Services offices are eligible for coverage.