Schedule G - Dependent Coverage.pdf

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ORS PUBLIC SCHOOL EMPLOYEES / YOUR INSURANCE BENEFITS / DEPENDENT COVERAGE

Dependent Coverage Eligible dependents for health, prescription drug, dental, and vision insurance plans include:

• Your spouse. If he or she is an eligible public school retiree, you will be covered together on one contract.

• Your unmarried child by birth or legal adoption until December 31 of the year in which he or she turns age 19. In the case of legal adoption, a child is eligible for coverage as of the date of placement. Placement occurs when you become legally obligated for the total or partial support of the child in anticipation of adoption.

• Your unmarried child by legal guardianship until age 18.

• Your unmarried child by birth or legal adoption who is a full-time student and dependent on you for support, until December 31 of the year in which he or she reaches age 25 or the end of the graduation month, whichever comes first. See Affordable Care Act below for more information.

• Your unmarried child by birth or legal adoption who is totally and permanently disabled, dependent on you for support, and unable to self-sustain employment. See coverage for disabled dependents below for more information.

• Either your parent(s) or parent(s)-in-law residing in your household - one set of parents or the other, but not both.

Coverage for your eligible dependents is the same as yours.

You are responsible for immediately notifying ORS of any change in your status or that of your dependents that would affect insurance eligibility. If it is discovered that an ineligible person is covered by you, that person will be terminated retroactively and you may be responsible for repaying any claims made on their behalf.

Required proof(s) for coverage

You will be asked to provide photocopies of the following:

• marriage certificate if you're adding a spouse,

• birth certificates as proof of age and relationship,

• IRS form 1040 that identifies the child as your dependent or a letter from your tax preparer

(on letterhead) declaring your dependent is eligible but files their own taxes.

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• school records as proof of full-time attendance, which must include:

◦ dependent's name,

◦ dates enrolled,

◦ name of institution,

◦ and number of credit hours or deemed full time

• court orders to prove legal guardianship (if applicable),

• and driver's license or tax returns as proof of residence for your parent(s) or parent(s)-in-law.

These documents are referred to as proofs, proving your eligibility for coverage. Learn more here about the required proofs you may need to submit to enroll a dependent in insurance. You can also view this short dependent eligibility proofs e-learning module.

Note: The timeframe to submit enrollment request and proofs for dependents is the same as enrolling yourself in insurances.

Coverage for disabled dependents

To ensure coverage for your incapacitated child, you will need to provide:

• a current letter from the attending physician detailing the disability, stating the child is:

◦ totally and permanently disabled, and

◦ incapable of self-sustaining employment

• and the IRS form 1040 that identifies the child as your dependent

Coverage for a disabled dependent can begin the first of the month after ORS approves his or her eligibility, so it is important to provide documentation early as possible. In some cases we may ask for additional information to determine medical eligibility. This may delay enrollment.

Note: The timeframe to submit enrollment request and proofs for dependents is the same as enrolling yourself in insurances.

Additional notes about insurance for your dependents.

Affordable Care Act

Federal law changes in 2010 extended coverage to adult children up through the age of 26;

however, the federal government has determined that this provision of the law does not apply to non-federal governmental retiree only plans, like the Michigan Public School Employees

Retirement System. Because of this, your dependents are not automatically eligible for the health plan until age 26 as they were under your active employer insurance plan.

COBRA insurance

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The retirement plan information that appears on this website is intended to summarize basic provisions of Public Act 300 of 1980, as amended.

Current laws, rates, and factors are subject to change. Should there be discrepancies between the information reflected here and the actual law, the provisions of the law govern.

Copyright 2019 State of Michigan

A federal law known as COBRA (Consolidated Omnibus Budget Reconciliation Act), allows your spouse or child the option of paying for continued health insurance coverage for up to 36 months after a qualifying event that results in the loss of eligibility. Your health insurance carrier may also offer a conversion policy for the dependents. Your dependents will be notified of these options by the health insurance carrier. Contact the insurance carrier for more information.

Survivor coverage

If you choose a survivor option for your pension and you have the Premium Subsidy benefit, your designated pension beneficiary can enroll in or continue group insurances after your death. If you choose your spouse as your survivor pension beneficiary, your eligible dependents who were covered at the time of your death will also continue to receive insurance benefits, as long as they remain eligible.

If you choose a survivor option for your pension and you have the Personal Healthcare Fund, any eligible beneficiaries and dependents who were already enrolled in insurance plans at the time of your death may continue to be enrolled in those insurance plans and they will continue to be responsible for the entire premium. If they terminate the plan at any time, they will not be able to re-enroll.

Divorce

If you divorce, your former spouse's coverage ceases as of the end of the month in which the divorce occurs. He or she may be eligible for COBRA continuation, however.

If you are covered under your spouse's plan at the time of divorce, and lose coverage, it is considered a qualifying event. Find more information about qualifying events and enrollment time frames here.

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