Eligibility Chart

The chart below identifies each plan's effective date, pre-existing exclusion and PCP or general dentist requirement. Refer to each plan's eligibility section for detailed eligibility information.

The information below is summary only.  You should rely on plan documents or certificate of insurance for additional details.

 

Type of Benefit

Network/Carrier

Additional Requirements

PCP or General Dentist Required

First Date of Eligibility
High Deductible Plan (HDP) with Health Savings Account (HSA) Medical - UnitedHealthcare Choice Plus Network

Mental Health - UnitedHealthcare

Pharmacy - CVS Caremark

Out-of-network coverage is available, but you pay a greater share of the cost		 To contribute to the HSA, you must
  • not be covered by another medical plan (unless an HDHP)
  • not be claimed as a dependent on someone else’s tax return
  • not be covered by a general purpose flexible spending account (FSA)
  • not be enrolled in Medicare, TRICARE or received care from a VA facility in last 3 months
No
First of month following 30 consecutive days of active full-time employment
PPO Medical Plan Medical - UnitedHealthcare Choice Plus Network

Mental Health - UnitedHealthcare

Pharmacy - CVS Caremark

Out-of-network coverage is available, but you pay a greater share of the cost		   No First of month following 30 consecutive days of active regular employment.
PEBC Dental Plan (PPO)
Delta Dental PPO and Premier Dentists
6 month waiting period for major services; 12 month waiting period for orthodontia
No
First of month following 30 consecutive days of active regular employment.
Dental DHMO Plan
Delta Dental Care USA DHMO Plan
 
Yes
First of month following 30 consecutive days of active regular employment.
Vision Plan
VSP Vision Plan
 
 
First of month following 30 consecutive days of active regular employment.
Employee Assistance Program (EAP)
Optum
Includes up to 5 (8 for first responders) face-to-face visits at no cost to you – per incident per year
 
First of month following 30 consecutive days of active regular employment
Employee Basic Life and AD&D (GLF)
The Hartford
Coverage amount varies by employer, paid by employer
 
First of month following 30 consecutive days of active regular employment
Optional Employee Term Life and AD&D (TLF)
The Hartford
If you are increasing current coverage or selecting for first time and not a new employee, subject to Evidence of Insurability (EOI)
 
First of month following 30 consecutive days of active regular employment. Increases in coverage subject to medical underwriting approval
Optional Spouse Term Life (SLF)
(AD&D coverage not available)
The Hartford
Employee must be enrolled in Optional Employee Term Life (TLF) in order to select Optional Spouse Term Life (SLF). SLF cannot exceed 50% of Employee TLF. If you are a current employee increasing coverage or adding it for first time, coverage is subject to Evidence of Insurability (EOI).
  
First of month following 30 consecutive days of active regular employment. Increases in coverage subject to medical underwriting approval.
Optional Dependents Group Term Life Insurance (DGL)
The Hartford
(Annual Enrollment) Not subject to Evidence of Insurability (EOI)
 
First of month following 30 consecutive days of active regular employment. Adding dependents or Increases in coverage effective subject to medical underwriting approval.
Long Term Disability
Standard Insurance Company
Not available in Parker County
 
First of month following 30 consecutive days of active regular employment.
FLEX Spending Accounts (general purpose and limited purpose)  
Administered by UnitedHealthcare
Limited purpose FLEX available to those enrolled in HDP
 
First of month following 30 consecutive days of active regular employment.
Long Term Care Insurance
Prudential Insurance Company of America
Not available to new enrollees
 
 
UnitedHealthcare Group Medicare Advantage 
(PPO)
No network
Providers who accept Medicare Assignment or file a claim for reimbursement
Must be enrolled in Medicare Part A and Part B
 
No
At retirement - First of month following signature date provided all other eligibility rules are met. First day of month in which 65th birthday occurs; if 65th birthday on first day of month, then first day of previous month. 
UnitedHealthcare Group Medicare Advantage (HMO)
UnitedHealthcare Medicare Advantage Network
Must be enrolled in Medicare Part A and Part B; limited service area
Yes
First of month following signature date on UnitedHealthcare Request for enrollment application, provided all other eligibility rules are met
PEBC PPO Plan
UnitedHealthCare Choice Plus Network
Available to a spouse/dependent not entitled to or enrolled in Medicare only if the retiree is enrolled in a PEBC UnitedHealthcare Group Medicare Advantage plan
No
Retiree must be enrolled in UnitedHealthcare Group Medicare Advantage (HMO) or UnitedHealthcare Group Medicare Advantage (PPO)