Changes Make It Easier to Get Coverage
There will be new and improved eligibility rules for coverage beginning August 1st. The Board of Trustees are pleased to make these changes and provide additional opportunities for individuals to earn and maintain coverage.
Just 10 weeks—or as few as 9 in some cases—will earn you 6 months of Tier 2 coverage beginning with the August 1st coverage period. Once you are enrolled in coverage, just 9 weeks every 6 months will continue your coverage. That means you can earn a year of continuing Equity-League health coverage by using a minimum of only 18 work weeks (9 weeks for each 6-month coverage period in some instances).
Remember, for coverage starting August 1st, we look at your weeks earned from June 2024 to May 2025!
Read on for full details…
Initial Eligibility/Requalifying After a Gap in Coverage
The first changes make it easier for you to earn your coverage as a new participant or when you return after a break in your coverage.
Starting August 1, 2025, you must work at least 10 weeks in a 12-month period to be eligible for any level of health coverage. This reduces the current requirement of 11 weeks to 10 weeks and applies to participants who are newly eligible or requalifying after a gap in coverage.
The level of coverage you qualify for is based on the number of weeks you work in covered employment.
- Tier 1: You must work 15 weeks or more in a 12-month period. THIS IS NOT CHANGING.
- Tier 2: You must work 10 weeks or more in a 12-month period. Reduced from 11 weeks to 10 weeks.
In addition to reducing the requirement to 10 weeks, a second change is being made that is also designed to help you qualify for coverage. If you do not have 10 weeks to use to qualify for Tier 2 coverage, you will still be able to qualify for Tier 2 coverage if:
- You have 9 weeks available in the applicable 12-month accumulation period, AND
- You worked and earned at least 9 weeks, whether you used those weeks or not, in the immediately prior 12-month accumulation period.
Note: If you have 10 weeks available, you must use those 10 weeks for Tier 2 coverage, regardless of whether you meet the new nine-week rule explained above.
Example: For coverage starting August 1, 2025, if you only have 9 weeks available during the accrual period of June 2024 through May 2025 (the accumulation period for coverage starting August 1, 2025), you can still qualify for Tier 2 coverage if you also earned at least 9 weeks in the previous 12-month accrual period (June 2023 to May 2024), whether those weeks were used or not.
Option to Buy Up to Tier 1 Coverage
If you meet either eligibility requirement for Tier 2 coverage, you have the option to buy up to Tier 1 coverage for an additional $95 per month or $285 per quarter.
Continuing Eligibility
In addition, it will be easier to maintain and continue your coverage.
Eligibility for Tier 2
If you are already enrolled in coverage, you only need 9 weeks to earn an additional 6 months of coverage for the next coverage period.
Example: You had Tier 1 coverage that was effective February 1, 2025. During the next accrual period (June 2024 to May 2025 for coverage starting August 1, 2025), you work 9 weeks. As a result of having those 9 weeks available, you will be eligible to continue Tier 2 coverage effective August 1, 2025, and will have the option to buy up to Tier 1 coverage.
Eligibility for Tier 1
The rules for qualifying for Tier 1 coverage are not changing.
- You must work 15 weeks or more in a 12-month period.
OR
- You must be eligible for Tier 2 coverage and then elect to buy up to Tier 1 coverage for an additional $95 per month.
If you qualify for Tier 1 coverage, you will still have the option to elect Tier 2 instead and use fewer weeks in order to preserve more weeks to use towards future eligibility determination. The number of Tier 2 weeks used depends on your eligibility type:
- If you qualify for initial coverage or you requalify after a gap in coverage: You can elect Tier 2 coverage by using 10 weeks (even if you have 9 weeks available in the applicable 12-month accumulation period and you have earned at least 9 weeks in the immediately prior 12-month accumulation period).
- Example: You qualify for Tier 1 coverage effective August 1, 2025, and you elect Tier 2 coverage. You use 10 weeks.
- If you already have Tier 1 coverage and you qualify to continue with Tier 1 during the next coverage period for an additional 6 months: You can elect Tier 2 coverage by only using 9 weeks (even if you have 10 weeks).
- Example: You requalify to continue Tier 1 coverage effective August 1, 2025. You elect Tier 2 coverage instead. You will only use 9 weeks.
If you are currently covered and do not have enough weeks to continue health plan coverage or maintain your current Tier of coverage, you will still be permitted to use weeks you earn in the two-month “waiting period” to extend eligibility for another 6 months of continuous coverage.
Example: You elected Tier 1 coverage effective February 1, 2025 through July 31, 2025. You work 9 weeks through the accrual period ending May 2025. And then you work 6 weeks during the months of June and July 2025, which enables you to continue your Tier 1 coverage effective August 1, 2025.
If you have less than 9 weeks, you can use your waiting period weeks to maintain continuous coverage through employment.
Example: You have Tier 1 coverage through employment that is effective February 1, 2025 through July 31, 2025. You have worked 3 weeks through the accrual period ending May 2025. And then you work 6 weeks during the months of June and July 2025 to continue with another 6 months of coverage effective August 1, 2025. You can elect to have Tier 2 coverage or buy up to Tier 1 coverage.
Eligibility Rules That Aren’t Changing
You earn eligibility for coverage based on the number of weeks you work. Each month, the Fund Office reviews the totals to determine who has earned eligibility for health coverage. You earn eligibility for 6 months of coverage at a time. There are still two months between the eligibility period and the start of coverage, and you have the option to defer your coverage start date, provided the required weeks are available in the subsequent look-back period. The premium to participate in the coverage for which you qualify will still be $300 per quarter to $585 per quarter if you elect to buy up to Tier 1.
Want More Information?
You can see more information about the current eligibility rules on the Health Plan Eligibility and Choosing Your Health Plan Coverage pages.