DEPENDENT HEALTH INSURANCE COVERAGE

If you elect coverage for yourself as an employee, you are also able to elect coverage for your Eligible Dependents on the later of:

1. the day you become eligible for your own medical coverage
2. the day you acquire an Eligible Dependent by birth, adoption or placement for adoption
3. the first of the month concurrent with or following the date of your marriage

You may enroll your dependent as long as:

• you submit a completed written enrollment form (available at the Human Resources office at Campus Services Building Room 237), and
• medical coverage is in effect for you (the active employee) on that day and
• you pay any required contribution for coverage of the dependent(s)

ELIGIBLE DEPENDENTS include:

• Spouse: The employee's lawfull Spouse as determined by the laws of the state where the covered employee resides.
• Dependent Child(ren): Any of the employee's unmarried children under the age of 19 years, for whom the employee provides primary support and maintainance and you claim as a dependent on IRS tax submissions within the meaning of the IRS Code Section 152(a) including:
  • natural child who lives with you
  • stepchild who lives with you
  • legally adopted child or child placed in anticipation for adoption who lives with you (the term placed for adoption means the assumption and retention by the employee of a legal obligation for total or partial support of the child in anticipation of adoption of the child and the child must be available for adoption and the legal adoption process must have commenced)
  • child who qualifies for benefits under a Qualified Medical Child Support Order
  • child for whom you have legal guardianship under a court order and the child lives with you

  Over age Child/Student Status: A child will continue to be eligible if the child has reached his/her 19th birthday, but has not reached his/her 24th birthday and attends an accredited program of secondary education or an accredited program of post-secondary education, including, a college, university, community or junior college, graduate school and accredited trade or business school on a full-time basis (Full time as defined by the institution attended). School vacation periods during any calendar year that interrupt but do not terminate a continuous course of study will be considered school attendance for those individuals who attend school on a full time basis.

  Over age Child/Disabled Status: An unmarried child who has reached his or her 19th or 24th birthday who, as evaluated by a physician, has a permanent or continuing mental or physical impairment and incapable of self-sustaining employment or self-sufficiency as a result of that impairment; and dependent chiefly on you and/or your spouse for support and maintenance and whom you claim as a dependent on IRS tax forms under the IRS Code 152(a). PEBP will require proof of disability at reasonable interval during the two years following the date the dependent reaches the limiting age of 19 or 24 and after this two-year period, PEBP may require proof not more than once each year.

DEPENDENT COVERAGE ENDS:

Coverage of a Dependent Child ends at the end of the month in which that child:

• reaches his 19th or 24th birthday, whichever is applicable; and
• voluntarily or involuntarily terminates full-time attendance at a high school, college, university, or graduates; or
• marries; or
• enters military or similar service anywhere

ADDING OR DELETING DEPENDENTS

Current employees can add or delete dependents during the annual open enrollment period or within 31 days of a qualified family status change. Qualified status changes include:

• A marriage
• Birth, adoption, legal guardianship, or placement for adoption of an eligible child
• Divorce or annulment
• Death of a dependent
• A child between the ages of 19 and 24 years becomes a full-time student
• Dependent becomes disabled
• Involuntary loss of coverage for dependent(s)
• Spouse obtains coverage through their employer
• You or your dependent become eligible for Medicare during the year
• Change of address resulting in a move from the health network coverage area
• Receiving a Qualified Medical Child Support Order

REQUIRED PAPERWORK FOR CHANGING COVERAGE

Employees who need to make changes to their health plan dependent coverage must submit supporting documents in addition to an enrollment form.

ADDING DEPENDENTS To add a dependent, the following paperwork must be submitted:

• Marriage - copy of certified marriage certificate
• Birth - copy of certified birth certificate
• Adoption - copy of court order signed by Judge
• Full-time Student Status - Full-time student status letter or signed statement from the registrar every semester/quarter and copy of certified birth certificate if one is not on file with PEBP
• Placement for the purpose of adoption - copy of court order signed by Judge
• Guardianship of new dependent - copy of court order signed by Judge
• Involuntary loss of dependent coverage - certificate of coverage from previous employer, and a copy of certified marriage certificate if one is not on file

DELETING DEPENDENTS To delete a dependent, the following paperwork must be submitted:

• Divorce - divorce decree; must have first page listing employee and dependent, also must have last page stating "Bonds of Matrimony have been dissolved" including Judge's signature
• Dependent no longer eligible for coverage under the plan - benefits enrollment form within 31 days of the event
• Dependent enters the military - must be stated on the benefits enrollment form