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Setting Up Eligibility Policy

This guide explains how to set up your eligibility policy: the rules that determine which employees qualify for which benefits, and when.

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Written by Regina Rovira

What's Changed (July 7th, 2026)

Eligibility is now set by benefit.

Previously, you set one company-wide policy and Vitable's Ops team manually configured the eligibility rules for each benefit if needed. Going forward, you set eligibility rules for each benefit yourself, so different benefits can have different rules. For example, VPC can have no waiting period while MEC has a 60-day waiting period.

Waiting periods now start on the date of a classification change, not the hire date.

If an employee's employment classification changes, their waiting period for the new benefit starts on the day that change takes effect, not on their original hire date. For example, an employee's waiting period can start when they move from part-time to fulltime.

If you're an existing customer, your current eligibility rules were migrated automatically.
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Setting Up Your Eligibility Policy

  1. Log into your Employer Dashboard > Benefits and click on the Set up policy.

  2. Click Get started to get to the Plans page

  3. On the Plans page, click the checkbox next to the plans you want to set up with the same eligibility policy.

  4. Define the Eligibility Rules needed to get these benefits.

  5. Define the Waiting Period (how long should new hires wait before benefits begin?).

  6. Set the Termination Policy (when someone becomes ineligible for benefits, when their coverage should stop?).

  7. Review and then click Confirm & activate

  8. Repeat the process to configure any remaining plans


Important Notes

  • You can't change an eligibility policy once Open Enrollment has started for that plan year.

  • Eligibility based on an hours-worked threshold (e.g., 30+ hours/week) is not yet supported.


ACA Autopilot and ACA Full-Time Eligibility

If you use ACA Autopilot, Vitable calculates whether an employee qualifies as full-time under the ACA employer mandate (Section 4980H) based on hours worked, measurement periods, stability periods, and your ACA policy. For ACA-regulated benefits (such as MEC and ICHRA), an employee is eligible if either:

  • They're employer-designated Full Time and have passed your ACA waiting period.

  • Vitable has determined they're ACA full-time based on their payroll history.

Once Vitable determines an employee is ACA full-time, they stay eligible for the applicable stability period even if their classification changes in the meantime.

Have a workforce with variable hours and want to learn whether ACA Autopilot is a fit? Contact success@vitablehealth.com.
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Questions?

If you'd like help with your eligibility policy, reach out to success@vitablehealth.com.

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