General Definitions & Enrollment Guidelines

General Definitions

1. "Active employee working full time on a permanent basis" is an employee working thirty (20) hours a week during a thirty (20) calendar day period of continuous service.

2. If an "Eligible Employee" is not reported to the BESA designated Administrator, intentionally or unintentionally, the employer must pay all back premium payments for that employee. Flagrant or continuous violations will result in group termination from the BESA programs.

3. A salaried employee must be paid in compliance with the minimum wage law. State taxes, federal taxes and compensation insurance must be paid on the salaried employee.

4. Employees covered by a health plan through a spouse or individual plan coverage need not be covered under this plan. A waiver form documenting spousal or individual coverage must be submitted to the BESA designated Administrator. Any exceptions must be documented and approved by the BESA designated Administrator and sponsored carrier.

5. Only "active employees" of a company that is an Exchange member can be covered. Any DBA company, employees and/or owners and officers are not eligible.

Underwriting Guidelines

1. "New" employer groups must submit the group application and other required data and forms at least 30 days prior to the proposed effective date. Employer groups should be discouraged from canceling or lapsing prior carrier coverage until approval is official from the BESA designated Administrator.

2. Retirees are eligible for coverage if they meet the BESA retiree definition. That is, "A retiree is an employee covered by a BESA sponsored plan for a minimum of 5 years, and combined with chronological age, adds to the sum of 65." This applies only to BESA member firms who provide and pay for retiree coverage, All necessary sponsored carrier participation and contribution requirements must be met.

3. Late enrollment must be medically underwritten. Late enrollment is subject to BESA sponsored carrier restrictions and/or limitations.

4. Dependents may not be enrolled unless the employee is enrolled.

5. Once an employer group cancels coverage with the BESA, they cannot be enrolled in the BESA plans for at least twelve (12) months.

This also pertains to firms who are owned individually or jointly by couples who terminate one business membership and reopen business under a different name. Any business who falls into these parameters will require the BESA Administrator review in order to maintain the integrity of the carriers.

Ineligible Groups

1. Employer groups with poor financial stability.

2. Any group failing to meet participation requirements of BESA sponsored carriers.

3. Any employer group previously participating in a BESA sponsored benefit plan who terminated coverage and has not met the "twelve (12) month wait" BESA re-entry requirement.