IU Residents
Eligibility and Enrollment Guidelines

On this page: Eligibility | Enrollment | Continuation Opportunities

Eligibility Guidelines

Eligible Employees

IU Residents appointed by the IU School of Medicine Office of Graduate Medical Education or the 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 flexible spending accounts, Life and AD&D insurance, Critical Illness insurance, and Supplemental AD&D insurance

You must enroll in these benefits within 30 days of hire, within 30 days of experiencing an IRS-qualifying life event, or during the annual Open Enrollment period each fall. If you are placed on leave at the time of initial eligibility, your coverage will become effective on the first day of active employment.

Eligible Dependents

The following dependents of a resident are also eligible coverage:

• Spouse (by marriage, either same- or opposite-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:
• The child has one of the following relationships to the resident or spouse:
  • A biological child; or
    
  • A lawfully adopted child; or
  • A stepchild of the resident; or
  • A child for whom the resident 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.
• Additional eligible individuals include children for whom the resident 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 resident (granted custody) for the purpose of adoption.

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.

Disabled Child Eligibility

Your dependent child’s health coverage may continue beyond age 26 if they are fully disabled. For the purposes of determining eligibility for IU-sponsored health coverage, a child qualifies for disabled child eligibility if they are:

• fully disabled, that is, incapable of engaging in self-sustaining employment because of a mental, intellectual or physical impairment; and
• primarily dependent on the resident 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 resident’s IU-sponsored health plan at the time he/she reaches age 26.

Written notification that the child meets the criteria for disabled child eligibility must be submitted to the university 30 days prior to the date their coverage would otherwise cease due to age (i.e. reach age 26).

Further written documentation and medical certification must be provided within 120 days 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, and failure to provide this information could result in termination of the child’s coverage.

Contact for questions or to request the form to certify your child as a disabled dependent.

Newborn Eligibility

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

However, for claims to be processed for that 31 day period and for continued coverage beyond the first 31 days, you must enroll the child in your IU-sponsored coverage within 30 days after the child's birth by (1) submitting a Life Event change through the Employee Center and (2) providing proof that the newborn is a qualified dependent (i.e. birth certificate, or hospital birth certification until birth certificate is available).

Enrollment Guidelines

Adding and Dropping Dependents Mid-Year

Outside of your new hire enrollment period and the annual Open Enrollment period, a dependent can only be dropped or added if you experience an IRS-defined qualifying life event, such as marriage, divorce, or the loss of outside coverage. Changes must be made within 30 days of the event by submitting a Life Event change online 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

An individual can't receive benefits from more than one IU-sponsored health plan simultaneously. This includes being covered as a resident on multiple plans, being covered as both the resident and a dependent, or being the dependent of more than one resident or employee.

Duty to Notify of Ineligibility

The resident must notify the university in writing of any change that affects their dependent’s eligibility, for example, marriage or divorce. A medical or dental plan enrollee ceases to be a covered dependent on the date they no longer meet the definition of a dependent, regardless of when notice is given to the university. The resident is responsible for notifying the university in writing within 30 days to initiate any reduction in premium contribution. Failure to provide timely notice to the university can jeopardize COBRA benefits and result in additional cost to the resident. There may also be tax consequences when coverage is provided for ineligible dependents.

Coverage Period

Your coverage as a resident is effective on the first day of active employment as an eligible resident 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, then submit claims for reimbursement once your coverage is activated. Once your enrollment is processed, coverage will be effective retroactive 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.

Continuation Opportunities

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.