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Dependent Coverage 

 

Eligible dependents of a member may participate in the same health, dental and vision plans as the member. For this reason, members wishing to add a dependent that is not enrolled in Medicare Parts A and B must disenroll from the Medicare Advantage plan in which they are enrolled and, instead, enroll in one of the non-Medicare Advantage health plans under the State Employees Group Insurance Program.  If adding a non-Medicare dependent outside the annual fall Open Enrollment Period, you must have a qualifying change in status event and must request the addition within 60 days of the event occurring.  A Group Insurance Enrollment/Change form must be completed and submitted to your retirement system along with the required eligibility documentation.

Documentation requirements must be met in order for the dependent to be added to and/or remain on the coverage. Eligibility for Spouse Life and Child Life insurance varies, see the Life Coverage page for information. Dependent coverage is an additional cost for all members. Dependent in certain categories must certify eligibility each year. Eligible dependents of the member include:

  • Spouse (does not include ex-spouses, common-law spouses, a new spouse of a survivor or persons not legally married).
  • Same-Sex Domestic Partner (enrolled prior to June 1, 2011).
  • Civil Union Partner (Same-Sex or Opposite-Sex).
  • Child from birth up to age 26, including:
    • Natural child.
    • Adopted child.
    • Stepchild or child of a civil union partner. Child for whom the employee has permanent legal guardianship.
    • Adjudicated child for whom a U.S. court decree has established a member’s financial responsibility for the child’s medical, dental or other healthcare.
  • Child age 26 and older, including:
    • Disabled. Child age 26 or older who is continuously disabled from a cause originating prior to age 26. In addition, for tax years in which the child is age 27 or above, eligible to be claimed as a dependent for income tax purposes by the employee.
    • Adult Veteran Child (non-IRS). Unmarried adult child age 26 up to, but not including, age 30, an Illinois resident and has served as a member of the active or reserve components of any of the branches of the U.S. Armed Forces and received a release or discharge other than a dishonorable discharge. Note: The premium for is 100% of the cost of coverage (member portion plus the State contribution), regardless of the number of dependents enrolled on the member’s coverage.
    • Other. The ‘Other’ category includes a dependent who is:
      1. A recipient of an organ transplant after June 30, 2000, and eligible to be claimed as a dependent for income tax purposes by the employee, except for a dependent child who need only be eligible to be claimed for tax years in which the child is age 27 or above, or
      2. An unmarried individual continuously enrolled as a dependent of the employee in the State Insurance Program (or CNA for university staff) since 2/11/83 with no break in coverage and eligible to be claimed as a dependent for income tax purposes by the employee. The period of time the dependent was enrolled with Golden Rule Insurance Company (prior to April 1, 1988) does not count toward the requirement of continuous enrollment.

Created 10/29/13