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About Eligibility Requirements

Am I eligible for healthcare?

You are eligible for health care benefits if you are a permanent full-time employee, permanent part-time employee or a part-time temporary employee who averages at least 30 hours of service per week over a 12-month measurement period. 

Married State Employees

When both spouses in a family are employed by the State of Ohio, each may elect single coverage, or one may elect family coverage provided that the spouse who elects single coverage may not be listed as a dependent under the family coverage.

Dependent Eligibility Requirements

 

Spouse

Spouse

Your current legal spouse as recognized by Ohio law.

Children Under Age 26

Children Under Age 26

Including:

  • Your biological children (married or unmarried);
  • Your legally adopted children: adopted children have the same coverage as children born to you or your spouse, whether or not the adoption has been finalized. Coverage begins upon placement/custody for adoption;
  • Your dependent stepchildren;
  • Foster children; 
  • Children for whom either you or your spouse has been appointed legal guardian; and 
  • Children for whom the plan has received a Qualified Medical Child Support order: the child must be named as your alternate recipient in the QMCSO. 

Note: Dependent children are only eligible for dental/vision benefits if unmarried and under age 23. Dependent children ages 19-22 with dental/vision coverage must be a student.

Children Age 19-22 for Dental and Vision Coverage

Children Age 19-22 for Dental and Vision Coverage

Including:

  • Your biological children (unmarried);
  • Your legally adopted children: adopted children have the same coverage as children born to you or your spouse, whether or not the adoption has been finalized. Coverage begins upon placement/custody for adoption;
  • Your dependent stepchildren;
  • Foster children; and
  • Children for whom either you or your spouse has been appointed legal guardian. 

Unmarried Children Incapable of Self-Care

Unmarried Children Incapable of Self-Care

Unmarried children who are incapable of self-support due to mental retardation, severe mental illness, or physical handicap, whose disability began before age 23 and who are primarily dependent upon you are eligible for coverage. When there is an unsuccessful attempt at independent living, a child covered pursuant to this provision may be re-enrolled for coverage, provided that the application is submitted within five (5) years following loss of coverage.

This coverage is not automatic. The required form may be obtained from your agency benefits specialist. After completing the form, submit it to DAS HRD HCM Benefits by fax at 614-728-3002 (a secure fax) or by email at das.hrd.hcm.benefits@das.ohio.gov

Periodically, but not more than once a year, proof of continued incapacity and dependence must be provided upon request. 

Persons NOT Eligible for Coverage as a Dependent

A spouse from whom the employee is legally divorced or legally separated
Children who are age 26 or older.
Live-in boyfriends or girlfriends
Parents or parents-in-law
Grandchildren (unless employee is the court-appointed legal guardian)
Adults who are not the employee’s or spouse’s child under guardianship of employee (brother, sister, aunt, uncle, etc.)
Common law spouse in which the relationship began in Ohio after October 10, 1991
Any other members of your household who do not meet the definition of an eligible dependent
A child who is eligible as an employee of the State of Ohio is not also eligible as the dependent of a parent who also is a State of Ohio employee, except as required by the Patient Protection and Affordable Care Act.

It is the employee’s responsibility to dis-enroll family members who are no longer eligible for coverage.

Knowingly providing false or misleading dependent eligibility information may result in any or all of the following actions by the State of Ohio: 

  • Loss of coverage;
  • Disciplinary action, up to and including removal; 
  • Collection action to recoup payments of benefits and claims paid for individuals determined to be ineligible dependents; and/or 
  • Civil and/or criminal prosecution.

Eligibility Matrix

 
General Contact

Department of Administrative Services
30 East Broad Street, 27th Floor
Columbus, Ohio 43215
614-466-8857 Local
800-409-1205 Toll Free

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