Benefits plan provisions and eligibility
As defined in Section 3359 of the Rules of the University Board of Trustees, all full-time faculty, contract professionals and staff members are eligible to receive group insurance benefits.
Employees must notify and provide documentation to the Office of Benefits Administration with 31 days to process a family status change.
When insurance is effective
A full-time faculty, contract professional or staff member is eligible for insurance effective on the first day of the month following appointment or date of hire. For example, for an employee hired on Aug. 20, his or her insurance benefits would begin on Sept. 1. If an employee starts on Sept. 1, insurance benefits will begin Oct. 1.
If the employee is absent from work on the day on which insurance would normally begin, insurance becomes effective the day the employee begins work or returns to active work.
If an employee is insured, eligible dependents may be:
- Defined under Chapter 3101 of the Ohio Revised Code
- Subject to Working Spouse Rule which requires spouses of University employees who have access to employer subsidized (at least 50%) medical and dental insurance to accept that insurance as primary. These spouses will only be permitted to have secondary access to University medical and dental insurance policies.
Same-sex domestic partner
- For more information, please see the University ’s Same Sex Domestic Partner Affidavit
- Subject to Working Spouse Rule which requires same sex domestic partners of University employees who have access to employer subsidized (at least 50%) medical and dental insurance to accept that insurance as primary. Same sex domestic partner will only be permitted to have secondary access to University medical and dental insurance policies.
Child(ren) under age 26
- Children includes biological children, adopted children, stepchildren and foster children under the age of 26.
- If the child is developmentally disabled or physically handicapped, insurance may be continued after age 26 under the circumstances described in the group policy.
Adult child(ren) (medical & prescription coverage only)
- Adult children include unmarried biological children, adopted children, and step children who are between age 26 & 27.
- Adult children must meet one of the following rules:
- Must not have access to any other group coverage
- Be a resident of the State of Ohio, or
- Be a full-time student if not residing in Ohio
Forms of documentation required to certify dependent eligibility
The University of Akron’s definition of an eligible dependent can be found above. If you are adding, a dependent for the first time proof of dependency is required at the time elections are made. Elections will not be processed until all required documentation is received by The Office of Benefits Administration. All Required Documentation MUST include date and/or year, employee name, and dependent's name. Please send documentation via campus mail +0602 or email to email@example.com
FOR SPOUSE: Provide copies of 2 forms of documentation listed below.
A copy of your marriage certificate AND
A copy of the front page of your most recently filed federal tax return confirming this dependent as a spouse, OR documentation dated within the last 6 months establishing current relationship status such as a joint household bill, joint bank/credit account, joint mortgage or lease, listing your name and your spouse’s name.
FOR DOMESTIC PARTNER: Provide 2 competed forms with 2 forms of documentation for enrollment.
A child is defined as your natural child, stepchild, legally adopted child, foster child, child under age 19 placed with you for adoption, child living with you for whom you or your spouse are custodian or legal guardian, or a child for whom you are required to provide health insurance by a Qualified Medical Child Support Order
FOR CHILDREN: Provide the appropriate copy of the form(s) of documentation requested below.
- A copy of the child’s birth certificate, naming you or your spouse as the child’s parent, or appropriate court order / adoption decree naming you or your spouse as the child’s legal guardian
- If applicable, a copy of a court-issued Qualified Medical Child Support Order (QMCSO) or other court order where you or your spouse are required to provide healthcare.
- If applicable, for an adult child (age 26 to 28) not residing in Ohio, a copy of the current college or university school schedule, or enrollment verification statement, that confirms the dependent’s status as a full time student (Full time status is typically 12 hours or more as an Undergraduate, and 9 hours or more as a Graduate Student).
- Up to age 26 (federal law – terminates on 26th birthday) children may be covered under your health plan as long as you supply documentation that they are your child (see requirements above). They can be married (there is no coverage for any dependents of the married child), they do not have to be residents of Ohio, they do not have to be students, and they can have other health coverage available to them.
- From age 26 to 28 (state law – terminates on 28th birthday) adult children may be covered by insurance that the employee purchases for a cost deducted via payroll as a post-tax deduction. Documentation that they are your child is required (see requirements above). They must be unmarried, they must be an Ohio resident or if they are attending school full-time in another state they are eligible for coverage (other state school enrollment documentation required), and they must not have other health care available to them.
- Coverage may extend to any age for a dependent who is incapable of self-support due to a mental or physical disability, is wholly dependent upon the employee for support and maintenance, and lives with the employee in a normal parent-child relationship.
When dependent insurance is effective
Each dependent will be insured beginning with the latter of:
- the first day of the month following appointment or date of hire of the employee, the date of becoming an eligible dependent - A dependent confined to a hospital on the date on which insurance would normally begin will become insured upon discharge from the hospital.
When insurance terminates
Insurance terminates when the employee
- leaves the University's employ,
- is no longer eligible, or
- when the group policy terminates.
A dependent's insurance terminates when the employee's insurance terminates or when the dependent is no longer considered eligible.
Individual Termination - all coverage terminate on the date of termination, except for group life insurance protection, which continues for 31 days.
Temporary Layoff - All coverage except for Long-Term Disability will be continued for up to four months.
Permanent Layoff - All coverage terminate on the last date of employment.
Leave of Absence - Any employee on a full or partial approved leave of absence continues benefits for up to one year.
Military Leave of Absence - Please refer to University Rule 3359-11-05.
Total Disability - All coverage except life insurance terminate at the earliest of the following, measured from the date of disability: a period of time equal to prior service, when the employee becomes eligible for Medicare or Ohio Retirement System benefits, or two years.
Surviving Spouse and Insured Dependents of Deceased Active Employees - All group benefits terminate on the last day of the second month following the month of death. For example, if an employee dies on March 2, benefits for dependents will terminate on May 31.
Retired Employees - Insurance coverage terminates for recipients of Ohio Retirement System and Alternative Retirement Plan benefits. For employees hired before January 1, 1992, comprehensive medical coverage for dependents of Ohio Retirement System retirees continues if:
the 9-month faculty retiree had ten consecutive academic years, contract professionals and staff had ten calendar years of full-time service with the University immediately prior to retirement, and
the dependent was eligible for insurance when the retiree's health insurance coverage terminated.
Arrangements may be made for continuation of coverage for the employee or eligible dependents under COBRA.
Family status change policy
An employee may revoke an election to all group benefits (except long term disability) during a period of coverage commitment and make a new election due to a change in family status. Events qualifying as a change in family status are defined as:
- Legal marital status
- Residence (moving in/out of the United States for six consecutive months)
- Entitlement to Medicare, Medicaid, or other insurance (ie: spouse’s open enrollment)
- Employment status (covered employee and dependent including starting employment ending employment, full to part-time status, or part to full-time status)
- Dependent satisfies or ceases to satisfy eligibility requirements
- Significant cost or coverage changes (25% increase or decrease)
- Number of dependents (Birth, death, adoption, marriage, divorce, etc.)
- Judgment, Decree or Order
All changes in family status must be reported and forms completed and returned within 31 days of the event. If an employee fails to complete a change in family status within 31 days of the event, the employee will be able to make changes at their next family status change or the next open enrollment period.
Family Status Changes require documentation of the event. Employees incurring a change in family status should contact The Office of Benefits Administration at 330-972-7090.
Working Spouse/SSDP Rule
The University’s Working Spouse/SSDP policy requires spouses/SSDPs of University employees who have access to employer subsidized (at least 50%) medical and dental insurance to elect that coverage as primary. These spouses are only permitted to have secondary access to University medical and dental insurance policies.
For additional information, employees should contact SummaCare 800.753.8429 or The Office of Benefits Administration at 330.972.7090 or firstname.lastname@example.org