Eligibility and Enrollment Guidelines
Fellowship Recipients with an award of $6,750 or more each semester, Fall and/or Spring, and enrolled in a minimum of six credit hours each semester (summer excluded) will be automatically enrolled in the benefit program. New enrollees will receive one ID card from Anthem for medical (including vision and prescription) and dental coverage. If you do not receive an ID card, please verify that your home address is correct.
Dependents that are eligible for medical and dental care coverage are:
- The Fellowship Recipient’s spouse* and/or
- Children who meet all of the following criteria:
- The child has one of the following relationships to the Fellowship Recipient, or spouse:
- A biological child; or
- A lawfully adopted child; or
- A stepchild of the Fellowship Recipient; or
- A child for whom the Fellowship Recipient 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 Fellowship Recipient 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 Fellowship Recipient (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.
* A spouse means one 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.
Disabled Child Eligibility
A Fellowship Recipient’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 Fellowship Recipient for financial support, and otherwise satisfies the IRS criteria as a dependent.
The newborn child of a covered Fellowship Recipient will be covered immediately from birth for the first 31 days if (1) the Fellowship Recipient 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 Fellowship Recipient’s medical or dental plan. In order for the newborn to have coverage beyond the first 31 days, the Fellowship Recipient 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 Fellowship Recipient is currently enrolled in Family or Fellowship Recipient/Child coverage) and (2) pay any contributions for the newborn child to continue as a covered dependent.
Adding and Dropping Dependents Mid-Year
Outside the announced Open Enrollment, a dependent can be dropped or added only if the Fellowship Recipient 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 Fellowship Recipient 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/Fellowship Recipient on more than one plan, or
- as both an Employee/Fellowship Recipient and a Dependent, or
- a Dependent of more than one Employee/Fellowship Recipient.
Duty to Notify of Ineligibility
The Fellowship Recipient is responsible for notifying the University in writing of any change that affects the Fellowship Recipient’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 Fellowship Recipient is responsible for notifying the University in writing within 30 days.
Fall Coverage Period: August 1 through December 31
Spring Coverage Period: January 1 through July 31
Coverage is not activated until the Fellowship Recipient’s award information has been approved in the system. This may take time at the beginning of each semester to process. Eligibility is determined solely by the department and must be verified with the department if there are any eligibility questions. Until health plan coverage is activated, the Fellowship Recipient may need to pay health care costs out-of-pocket and file claims once coverage is activated.
Fellowship Recipient coverage will terminate when the Fellowship Recipient 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 on continuation of coverage in the event of loss of health care coverage, please refer to the information on COBRA.