Eligibility and Enrollment Guidelines
IU Residents appointed by the IUSM Office of Graduate Medical Education or IU School of Optometry are eligible to receive certain benefits, including medical and dental coverage, as follows:
- Full-time (75-100% FTE): Eligible for all benefits
- Part-time (50-74% FTE): Eligible for all benefits except TSB pre-tax spending account and Personal Accident Insurance
Dependents that are eligible for medical and dental care coverage are:
- The employee's spouse* and/or
- Children who meet all of the following criteria:
- The child has one of the following relationships to the employee, or spouse:
- A biological child; or
- A lawfully adopted child; or
- A stepchild of the employee; or
- A child for whom the employee or spouse has been legally appointed sole guardian for an indefinite period of time; and
- 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.
- A child for whom 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 such child may begin from the point the child is placed with the employee (granted custody) for the purpose of adoption.
- Proof that an individual is a qualified dependent (marriage or birth certificate, guardianship orders, as applicable) 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.
An employee's covered dependent child's medical coverage may be continued beyond the maximum age for coverage if the child meets the definition of "fully disabled." Proof that the child is fully disabled must be submitted in writing no later than 30 days prior to the date that dependent coverage would have ceased. The University has the right to require, at reasonable intervals, proof that the child remains fully disabled, is dependent on the employee for financial support, and otherwise satisfies the IRS criteria as a dependent for the purpose of excluding University contributions and the value of covered services from the employee's gross income.
The newborn child of a covered employee will be covered immediately from birth for the first 31 days if (1) the employee was covered under the Plan on the child's date of birth, and (2) the newborn meets the definition of eligible dependent. Notice to the Plan Administrator does not add the newborn to the employee's medical or dental plan. In order for the newborn to have coverage beyond the first 31 days, the employee must (1) enroll for dependent coverage, or add the dependent to existing coverage by submitting applicable forms to the Human Resources office within 30 days after the child's birth (even if the employee is currently enrolled in Family or Employee/Child coverage) and (2) pay any contributions for the newborn child to continue as a covered dependent.
Outside Open Enrollment, a dependent can be dropped or added only if the employee experiences an IRS-defined Life Event Change, for example: marriage, divorce, or loss of coverage under the spouse's health plan. Changes must be made within 30 days of the date of the Life Event Change. After that time, the employee must wait until the next Open Enrollment.
No individual may be eligible for benefits under more than one IU-sponsored health plan. Ineligible coverage includes an individual covered as:
- the Employee on more than one plan, or
- as both an Employee and a Dependent, or
- a Dependent of more than one Employee.
The employee is responsible for notifying the University in writing of any change that affects the employee's dependent eligibility, for example, marriage or divorce. A medical or dental plan enrollee ceases to be a covered dependent on the date the enrollee no longer meets the definition of a dependent, regardless of when notice is given to the University. The employee is responsible for notifying the University in writing within 30 days to initiate any reduction in premium contribution.
Employee coverage becomes effective on the first day of active employment as an eligible employee, if the employee enrolls within 30 days of such employment. Coverage is not activated until the employee's health plan enrollment form is received and processed. Until health plan coverage is activated the employee may need to pay health care costs out-of-pocket and file claims once coverage is activated.
In the event that an employee is placed on leave at the time of initial employment, the employee's coverage will become effective on the first day of active employment.
Employee coverage will terminate when:
- Employment terminates, or
- The employee ceases 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 concerning opportunities for continuation of coverage in the event of lost health care coverage due to a change in employment, or the loss by a spouse or dependent of group health care coverage under an Indiana University sponsored health care plan due to changes in family status, please refer to the information on COBRA.