Who is eligible for coverage?
You are eligible for coverage if you meet any one of the following:
1. You were permanently employed by the District on a full-time basis prior to July 1, 2000 and were working at least 20 hours per week;
2. You were permanently employed by the District as a certified employee after July 1, 2000 on a full-time basis and are working at least 20 hours per week;
3. You are permanently employed by the District as a non-certified employee after July 1, 2000 on a full-time basis and are working at least 30 hours per week;
Temporary or substitute employees are not eligible.
If eligible, Certified employees - coverage begins the first day of the month following date of hire, Non-certified employees - coverage begins the first of the month following 30 days of employment
You may also elect to cover your eligible dependents.
Dependent eligibility
Dependents eligible for District subsidy include:
Your lawful spouse or Civil Union partner who is not eligible for group health coverage at their own place of employment. (Spouses or Civil Union partners covered at their own place of employment may be eligible for the Spousal Insurance Reimbursement Plan, as described below.)
Children eligible for coverage under the Plan up to age 26 (age 30 if military vet) are defined as your; natural born child, step child, legally adopted child, a child who has been placed with you for adoption pursuant to an interim court order, a child who is recognized under a Qualified Medical Child Support Order, and any child who lives with you in a parent-child relationship for whom you are a legal guardian. Recently issued federal regulations specify that a dependent child can qualify for this coverage even if he or she is no longer living with the parent, is not dependent on a parent's tax return or is no longer a student. Both married and unmarried, your adult dependent children can qualify for the dependent coverage extension, although that coverage does not extend to a young adult's spouse or children.
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SPOUSE INSURANCE REIMBURSEMENT PLAN
If a subsidy is available for your spouse's premiums and/or claims:
Premiums are reimbursed once a month. A signed Premium Reimbursement Affidavit is required in order to be reimbursed. If there is a change in premium, please complete a Premium Reimbursement Affidavit and return to Marnie Lalo in Human Resources. The plan will reimburse in-network deductibles, coinsurance and copays based on District 155's in-network benefits. Claims are reimbursed twice a month. Submit a copy of the Explanation of Benefits (EOB) from your spouse's insurance plan indicating how the claim was processed. The EOB, accompanied by a claim form is required for payment.
Should there be a change in your spouse's employment, insurance company, medical benefits, and/or contributions, you must notify the District within 31 days.
Want to receive premium and claim reimbursements faster? Complete the DIRECT DEPOSIT form, attach a voided check and mail it to Group Administrators at the address is on the form. All premium and claim reimbursements will be deposited directly into your checking account. No more waiting for reimbursement checks in the mail!
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ADULT DEPENDENT CHILDREN OVER THE AGE OF 23
A dependent child between ages 26 up to age 30 can apply for medical benefits under the plan at no additional cost to you. However, if you are have single coverage under the medical plan and are adding a dependent, you will pay premium for family coverage. There will be an additional cost to you to add your dependent child onto your dental and/or vision coverage who is age 23 up to age 26 or age 27 up to age 30 if they are a returning military veteran. See Marnie Lalor for further details and rates.
A spouse or child on active military duty is not eligible for coverage under the Plan, nor are your parents even though you may support them.