This chart briefly outlines basic eligibility requirements for employees and their dependents.

Eligibility limitations may vary among groups, so please consult the Group Health Service Contract, Evidence of Coverage, Group Policy/Certificate of Insurance or contact your Blue Shield account manager for special provisions related to your company.

Type of Enrollee Requirement for Coverage
Employee - Permanent, Year-Round, Full-Time
  • Works at least 30 hours per week.
  • Performs job duties at your company's usual place of business.

Employee - Part-Time

Only applies to groups who have purchased this coverage

  • Works 20 to 30 hours per week
Employee - Temporary Not eligible for Blue Shield group coverage unless your Group Health Service Contract or Policy includes a special provision extending coverage to them.
Sole owner or partner of a partnership
  • Full-time employee
  • Works at least 30 hours per week.
  • Performs job duties at your company’s usual place of business.
  • Qualifies as an employee under your company’s Blue Shield group health service contract.
Spouse Legally married spouse who is not legally separated from the employee.
Domestic Partner
  • Domestic partner who is not terminated from the domestic partnership.
  • Domestic partners are covered under the same terms and conditions as spouses.
Dependent Children

Child of an employee (or employee's spouse or domestic partner) by birth, legal adoption, or placement for adoption, who is under age 26* or older if disabled.

*Health reform redefined dependent children as of September 23, 2010 for group plans upon renewal after September 23, 2010, or the first renewal date thereafter.

Disabled over-age
dependent children

If a disabled child who is covered under a Blue Shield plan reaches the maximum age limit, coverage may continue if the child meets both of the following criteria. He or she is:

  • Incapable of self-sustaining employment because of a mentally or physically disabling injury, illness, or condition, and
  • Unmarried and dependent on the member for economic support.
Individuals ineligible
for group coverage

If part-time and temporary employees who are not eligible for your group coverage express interest in finding a plan that’s right for them, they can apply directly to Blue Shield for health coverage through an Individual and Family Plan.

Please contact your Blue Shield account representative for more information.

Please reference your Administrator's Guide for more detailed information.