Eligibility Rules for Spouse and Dependents

APSCUF Faculty and Coaches, Nonrepresented, OPEIU, POA

Covering Dependents Under Your Health Care Coverage
You may add/drop dependents during annual open enrollment or if you experience a qualifying life event which allows for a change in coverage. You will need to provide any required original documentation (e.g., birth certificate) to verify their eligibility, and you must provide their Social Security Number. If the dependent is not eligible for a Social Security Number, please contact your university human resources office for direction.

Who is eligible for coverage under the State System health plans?
The following categories of individuals may be eligible for coverage under the State System Group Health Plan for active employees:

 

1. Legal spouse

If a spouse is eligible for coverage under his/her employer plan, the following rules apply:

Date of Employment Rules for Spouse Eligibility

Hired Prior to July 1, 2001

 No restriction on spouse and his/her eligibility for State System health coverage.

Hired July 1, 2001 to June 30, 2013

 Spouse eligible for fully paid employer coverage through his/her employer must be enrolled in his/her employer’s coverage, and State System health coverage will provide benefits as secondary payer only.

Hired on or After July `1, 2013 

 If an employee enrolls a spouse in the State System health coverage and that person is eligible for coverage under his/her own employer’s plan, the spouse shall be required to enroll in his/her own employer’s plan for primary coverage as a condition for eligibility for secondary coverage under the State System plan regardless of the cost to spouse of that coverage.


2. Children under 26 years of age who meet the following requirements:

  • A natural child of your own.
  • A legally adopted child (including a child living with the employee during the probation period).
  • A stepchild.
  • A minor child for whom the employee is the court or agency appointed legal guardian, as evidenced by the court or agency order establishing guardianship.
  • A child over the age of 18, for whom the employee was the child’s court or agency appointed legal guardian prior to the child’s 18th birthday.
  • A newborn child of an employee is automatically covered from the moment of birth to 31 days after the date of birth. To be covered as a dependent beyond the 31-day period, the newborn child must be added as a Dependent through the university human resources office within 60 days from date of birth.
  • A child of a domestic partner (if the eligibility above has been met)

3. Unmarried dependent child 26 years of age or older, who is incapable of self-support because of a physical or mental disability that commenced before the age of 26.  

 

More about adult children to age 26:

  • Student status is not required.
  • Your adult children can be married. If married, the coverage does not extend to your adult children’s spouse, or to your adult children’s own children.
  • Your adult children do not have to live with you, be financially dependent on you, or be claimed as a dependent on your tax return.
  • The extension of coverage of adult children to age 26 only applies to the State System Group Health plan for active employees. For individuals enrolled in a State System Annuitant Health Plan, these plans cover children up to age 19, or up to age 25 if a full-time student.