Employee Matters
This column is prepared by staff from the Office of Human Resources. E-mail questions to benefits@ohr.wisc.edu or call 262-5650. For more information, visit http://www.bussvc.wisc.edu/ecbs/ecbs.html.
Dependent Status
Anyone with dependent children covered by their health insurance, dental and excess medical, dental insurance, spouse and dependent life insurance should review their benefits package annually. Dependent eligibility is determined by age, full-time student status, financial dependency and marital status. Dependent’s eligibility varies by plan.
Where is eligibility information located?
See “Coverage End Dates for Dependents” under General Benefit information on our Web site. The chart outlines the insurance plans that provide coverage for dependent children, as well as each plan’s eligibility rules. One of the eligibility rules is that the dependent must be a full-time student.
What is the definition of full-time student?
A full-time student is defined as one who is enrolled in an institution that provides a schedule of classes and whose principal activity is education for a specified number of credits. A person is considered enrolled on the first day of classes. Enrollment is considered continuous during any intervening vacation period.
Does each plan monitor eligibility?
Yes, all insurance plans monitor eligibility. If you have dependent children covered under health insurance, dental and excess medical, and dental insurance, the provider will mail you a dependent questionnaire to verify continued eligibility. Plans terminate coverage if you do not return the questionnaire.
If my dependent is no longer eligible, do I need to notify my employer?
Yes, you must complete a health insurance change form or application form identifying the dependent that is no longer eligible.
How many forms must I complete?
In some cases, the dental and excess medical and the dental plans will accept the health insurance information change form to remove the dependent from their plan.
I’m planning to change health plans during the annual Dual Choice enrollment period; where do I mail the questionnaire?
You must return the questionnaire to your current health plan, not the plan you will have for 2007. The information will be shared with your new plan.
What happens if I fail to respond?
Coverage for the dependent(s) will terminate on Dec. 31. Claims will be denied, and pharmacy benefits will not be available. To reinstate coverage for a dependent in this situation, you will need to complete a health insurance information change form to add the dependent back to your coverage and provide proof of student status.
Why is it important to report dependent status changes promptly?
If you do not report changes, you and the university may be overpaying premiums. In addition, you and your dependents may miss deadlines for COBRA continuation eligibility and your dependents may not be eligible for re-enrollment if they once again become eligible.
When should dependent status changes be reported?
Most changes must be reported within 30 days and require you to file a new application or information change form. Forms are available at http://www.bussvc.wisc.edu/ecbs/emp-forms-listing-page.pdf
Whom do I contact with further questions?
Send your questions to benefits@ohr.wisc.edu or call 262-5650.