Eligibility for Medical and Dental Plans

Eligibility and Enrollment Guidelines

Eligible employees

Full-time (75% FTE or greater) appointed academic and staff employees are eligible for medical and dental plan enrollment.

Enrollment in these plans must be completed within 30 days of being hired into a benefits eligible position, within 30 days of an IRS qualifying Life Event or during Open Enrollment.

If you are placed on leave at the time of initial eligibility, your coverage will become effective on the first day of active employment.

Note: J-1 Visa holders are only eligible for the Anthem PPO $500 Deductible medical plan due to the U.S. Department of State regulations regarding the maximum deductible limit of $500.

Eligible dependents

Eligible dependents include the eligible employee’s:

  • Spouse (by marriage, either opposite-sex or same-sex, legally entered into in one of the 50 states, the District of Columbia, or a U.S. territory or a foreign country); and/or
  • Children who meet all the following criteria:
    1. The child has one of the following relationships to the employee or spouse: a biological child, lawfully adopted child, stepchild of the employee, or child the employee or spouse has been legally appointed sole guardian for an indefinite period of time; and
    2. The child is age 25 or under (eligibility ends at the end of the month in which the child reaches age 26) or qualifies for Disabled Child Eligibility.
  • Additional eligible individuals include children who the employee is legally required to provide health care coverage under a Qualified Medical Support Order, as defined by ERISA or an applicable Indiana state law.
  • When an adoption is in the legal process, coverage for the adopted child may begin from the point the child is placed with the employee (granted custody) for the purpose of adoption.

Required Documentation
Documentation providing proof that an individual is a qualified dependent (e.g., marriage or birth certificate, guardianship orders) is required at the time of initial enrollment and periodically thereafter. Failure to provide proof of dependent eligibility within 30 days of the university's written request for such proof may result in termination of health plan coverage.

Newborn eligibility

Newborn children are automatically covered from birth for a period of 31 days if (1) you are covered under an IU-sponsored healthcare plan on the child's birthdate, and (2) the newborn meets the definition of eligible dependent.

However, for claims to be processed for that 31 day period and for coverage to continue beyond the first 31 days, you must enroll the child on your medical plan within 30 days after the child's birth. You can do this submitting a Life Event change request through the Employee Center, and providing documentation that the newborn is a qualified dependent (i.e. birth certificate, or hospital birth certification until birth certificate is available).

Disabled child eligibility

Your dependent child's healthcare coverage may be continued beyond age 26 if they are "fully disabled." For the purposes of determining eligibility for IU-sponsored medical and dental coverage, a dependent child qualifies for disabled dependent eligibility if they are:

  • fully disabled, that is, incapable of self-sustaining employment because of a mental, intellectual, or physical impairment; and
  • primarily dependent on the employee for support and maintenance and does not have personal resources sufficient to be fully self-supporting (for example, trust funds or settlements); and
  • unmarried; and
  • covered under the employee’s IU-sponsored health plan at the time he/she reaches age 26.

Certification that the child is fully disabled and meets the above criteria must be submitted to the university in writing no later than 30 days prior to the date that their coverage would have ceased under an IU-sponsored medical and dental coverage due to age (at the end of the month in which the child reaches age 26).

Further written documentation and medical certification must be provided within 120 after the dependent would normally become ineligible. The university has the right to require proof that the child continues to meet the requirements for disabled dependent eligibility. Failure to provide this information could result in termination of a child’s coverage.

Health savings account (HSA) eligibility

Enrollment in a high deductible health plan (HDHP) provides you with the opportunity to also enroll in a Health Savings Account (HSA). However, you must meet additional IRS-defined eligibility criteria to enroll in and contribute to an HSA.

Enrollment Guidelines

Adding or dropping dependents mid-year

Outside of your 30-day new hire enrollment period or Open Enrollment, a dependent can only be dropped or added if you experience an IRS-defined life event, such as marriage, divorce, or loss of coverage under your spouse's health plan. Changes must be made within 30 days of the event by submitting a Life Event change through the Employee Center. After 30 days, changes will not be accepted, and you must wait until the next Open Enrollment period to make any plan changes.

Dual coverage

Individuals cannot be enrolled under more than one IU-sponsored healthcare plan. Ineligible coverage includes an individual covered as:

  • the employee on more than one IU plan, or
  • as both an employee on one IU plan and a dependent on another IU plan, or
  • as a dependent of more than one IU employee.

Enrollment rules for IU spouses

University policy does not allow IU spouses to enroll under the lower-compensated spouse. If you and your spouse are both eligible for IU-sponsored coverage, you have two options:

  1. Each employee can enroll as “employee only” or “employee with children” in separate plans under their own salary bands; or
  2. Both can enroll in one plan as “employee with spouse” or “family” in the higher compensated spouse’s salary band.

Notifying the university of ineligibility

You are responsible for notifying the university in writing within 30 days of any changes that affect your dependent’s eligibility, for example, marriage or divorce. Regardless of when notice is provided to the university, a medical or dental plan member ceases to be a covered dependent on the date they no longer meet the definition of a dependent. Failure to provide timely notice to the university can jeopardize COBRA benefits and result in additional cost to the employee. There may also be tax consequences when coverage is provided for ineligible dependents.

Coverage Period

Your coverage as an employee is effective on the first day of active employment as an eligible employee as long as you enroll within 30 days of becoming eligible (typically your date of hire). However, your coverage will not be activated until your benefit enrollments are received and processed by the university and the plan vendor. This may result in you having to pay for healthcare costs out-of-pocket for a short period of time, however, you can submit claims for reimbursement once your coverage is activated. Once your enrollment is processed, coverage will be applied retroactively to your eligibility date.

If you are placed on leave at the time of initial employment, your coverage will become effective on the first day of active employment.
Your coverage will terminate when your employment terminates or you cease to be a member of the eligible class for coverage. Dependent coverage ends on the date the dependent no longer meets the criteria for dependent eligibility.

For information on opportunities to continue your IU-sponsored healthcare coverage following a change in employment or the loss of coverage by a spouse or dependent due to changes in family status, please refer to the COBRA web page. For information related to continuing health insurance as an IU retiree, refer to the Retiree benefits web page.