Eligibility

ELIGIBLE EMPLOYERS

ELIGIBLE EMPLOYEES:

Refer to the Industry Tables (also referred to as "SIC TABLES") in the brochure for classification of eligibility.

ELIGIBLE DEPENDENTS:

PARTICIPATION RULES

The employer must pay 100% of the employee premium.

Dependent Participation

Option A – If the employer pays 50% or more of the dependent premium there is no percentage participation requirements.

Option B – If the employer contribution is 0% to 49% of the dependent premium, then 75% of the eligible dependents must enroll for coverage to be issued.

The employer may choose to cover employees only, however, if dependent coverage is elected to be added by the employer at a future date it may only be added on the employer anniversary date.

If an employee or dependent is covered under another “group” dental or vision plan and proof is submitted, they may waive out by completing a Waiver and Declination of Coverage Form and are excluded in the calculation of participation requirements.

If a dependent refuses coverage for any other reason, they may NOT enroll at a future date under the Delta DPO. There is an open enrollment under DeltaCare 30 days prior to the Employer's anniversary date.

Failure to enroll eligible employees could cause the employer to become ineligible to continue coverage with the trust.

Industry Table (SIC TABLE)