Eligibility

If you are covering a spouse or domestic partner on the Medical Plan, you must complete the Working Spouse Surcharge Form. No spouse will be eligible or be enrolled in a Medical Plan until this form is completed and returned.  If you choose to cover your spouse or domestic partner on your medical coverage, and your spouse or domestic partner has access to medical coverage through his or her employer, you will be charged an additional $30 per week as a spousal surcharge.  This form must be renewed each Annual Enrollment Period.

 
Working Spouse Surcharge Form

If you cover a domestic partner, a declaration of common law marriage or an Affidavit of Domestic Partnership is required.

Eligible children include your biological children, your spouse or domestic partner’s biological children, adopted children, stepchildren, and legal wards.

You must complete the dependent verification process for all newly added dependents.

• became disabled prior to turning age 26;
• is primarily dependent on you for support;
• is enrolled in the Medical Program (or another major medical group health plan) on the day immediately prior to attaining age 26;
• is incapable of self-sustaining employment because of medical or physical disability; and
• for whom application for extended coverage as a disabled dependent child is made within 31 days after reaching the age limit of 26 or being enrolled in the Medical Program.

You must complete the dependent verification process for all newly added dependents.