IU Residents
Eligibility and Enrollment Guidelines

On this page: Eligibility | Enrollment | Continuation Opportunities

Eligibility Guidelines

Eligible Employees

IU Residents appointed by the IUSM 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, and Supplemental AD&D insurance

Eligible Dependents

Dependents that are eligible for medical and dental care coverage are the resident’s:

• 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 of 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 healthcare coverage may be continued beyond the maximum age for coverage (age 26) if the child meets the definition of "fully disabled." For the purposes of determining eligibility for IU-sponsored medical and dental coverage, a dependent qualifies for disabled dependent eligibility if:

• fully disabled, that is, incapable of engaging in self-sustaining employment because of a mental or physical disability; and
• dependent on the resident for support and maintenance and does not have personal resources sufficient to be 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.

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 proof that the child continues to meet the requirements for disabled dependent eligibility at reasonable intervals.

Newborn Eligibility

Your newborn child will be covered immediately from birth for the first 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, notice to the university of the birth does not add the newborn to your plan. In order for the newborn to have coverage beyond the first 31 days you must enroll the child in IU-sponsored coverage within 30 days after the child's birth by (1) submitting a Life Event change through the Employee Center.

Enrollment Guidelines

Adding and Dropping Dependents Mid-Year

Outside of Open Enrollment, a dependent can only be dropped or added if you experience an IRS-defined Life Event, for example: 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

No individual may be eligible for benefits under more than one IU-sponsored health plan. Ineligible coverage includes an individual covered as:

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

Duty to Notify of Ineligibility

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.

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 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.

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.