Eligibility
Before you and your dependents can start using the benefits the OLDC-OCA Insurance Fund offers, you must first become eligible.
Initial Eligibility
Once an active member works at least 450 hours in a six-consecutive month period, he or she is eligible for insurance benefits on the first day of the following month. For example, if you worked 450 hours or more in the months of April, May, and June; you would generally become eligible for insurance benefits starting in July. Your contractor must report and pay the contributions due before you will become eligible. There is a one-month lag in contractors reporting working hours. This lag in reporting will result in a delay of you being notified of your eligibility. For more information on eligibility, review pages 17-43 in the Insurance SPD.
The reporting lag results in your eligibility being established retroactively. If you or any of your eligible dependents have any insurance claims after your eligibility date, but you are not notified of your eligibility, you can have the claims resubmitted for processing and payment.
Continuing Eligibility
If you meet the minimum hours criteria for any of the three calculations for a given month, you will be eligible for that month. Your eligibility will continue if you work at least:
- 250 hours or more in the first 3 months of the 4 months immediately preceding the month of coverage; or
- 500 hours or more in the first 6 months of the 7 months immediately preceding the month of coverage; or
- 1,000 hours or more in the first 12 months of the 13 months immediately preceding the month of coverage.
An Eligibility Calculation Chart is available to see an overview of how eligibility works for years 2021-2025.
Self-Payments/COBRA
When your eligibility based on working hours ends, you can make 12 months of self-payments to continue your coverage. The amount you are billed varies from month-to-month. This is because the amount you are billed is based on the least number of hours needed to maintain your eligibility for the month, multiplied by the current contribution rate for the Insurance Fund. If you continue to make COBRA payments after 12 months, the monthly amount due will change to a fixed rate starting with your 13th month of COBRA and will continue through month 18. For more information on self-payments/COBRA, review pages 38-41 in the Insurance SPD.