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Eligibility
State
of Ohio employee health plans do not contain pre-existing condition exclusions;
therefore coverage is available to you and your eligible dependents regardless
of current health or health history.
If your employment status changes
from part-time to permanent and you want health care coverage,
you must contact your payroll or personnel officer within
31 days to sign up for health care coverage. If you do not
sign up then, you must wait until the next open enrollment
period.
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Employee
Eligibility
You are eligible for health care benefits if you are a permanent
full-time or permanent part-time employee, which includes established-term
regular; established-term irregular, appointment types 8, 9, 17, 18, 20 and 21; Judges and other elected or appointed officials.
Employees
classified as student help or college interns or whose appointments
are temporary, seasonal, interim or intermittent are not eligible
for health coverage.
Husband
and Wife State Employees
When husband and wife are both employed by the state, both employees cannot
carry family coverage. You have the following options:
- Both may
carry single coverage
- Both may
be covered by one family plan
- One employee
may carry family coverage and the other single, but the spouse
with single coverage may not be listed as a dependent under
the family plan.
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Eligible
Dependents
The following people are eligible to enroll as dependents:
- Your current
legal spouse
- You and your legal spouse's unmarried
children (including legally adopted children, children for whom either
has been appointed legal guardian and dependent stepchildren and
foster children who normally reside with you until the end of the
month in which they reach age 19).
- Your unmarried
children age 19 or older who are attending
an accredited school and are primarily dependent on you for maintenance
and support, are eligible until the end of the month in which they
either reach age 23 or cease being a student - whichever occurs first.
Student coverage is not automatic. Your health plan will periodically request proof of school enrollment. When you provide this proof, your dependent will continue to be covered. If the requested proof is not provided to your health plan, coverage ends the end of the birthday month. |
To
be considered primarily dependent, the dependent must receive
the majority of his/her essentials such as food, clothing
and shelter from the employee and be enrolled in an accredited
school. Attendance at an accredited school may be either
full time or part time. Students are permitted to miss one quarter/semester per school year and still retain their coverage. |
- Children of
divorced or separated parents who are not residing with you but who
you are required by law to support.
- Unmarried children
of any age 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. 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.
- 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.
- Current stepchildren
living in the employee’s home over 50% of the time.
- Under all health
plans, coverage for your dependents ends no later than the last day
of the month in which they turn 23, unless they have been granted an extension as described above.
- In cases of
two state employees who are married and who have legally separate
dependents, the employee who has coverage as a spouse may be included
as a covered dependent as well as children not residing with the employee,
but for whom the spouse is required by law to provide health insurance.
- Dependents of
divorced employees may be enrolled on both parents’ family plan pursuant to a court order or joint custody agreement.
However, health plans do not allow duplicate payments for services
and may not coordinate benefits. Check details with your plan(s).
Examples of Persons
Not Eligible for Coverage as a Dependent
- A spouse
from whom the employee is legally divorced or separated
- Dependents
age 19 to 23 not enrolled in an accredited school
- Same sex
partners
- Live-in
boyfriends or girlfriends
- Parents
or parents-in-law
- Grandchildren
(unless employee is the court-appointed legal guardian)
- Married
children
- Children
older than age 22 who are not disabled or attending an accredited school
- Employee,
spouse or child currently in the military service. See page 6 for more information.
- Adults under
guardianship of employee
- Common Law
spouse in which the relationship began after October 10, 1991
- A child
who is eligible as an employee of the state or who receives health care coverage through their own employment
- Current
and former stepchildren who do not reside with the employee more
than 50% of the time
- Any other members of your household who do not meet the definition of an eligible dependent
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Grandchildren of a covered employee
are not considered dependents of the employee unless the
employee furnishes legal proof of adoption or legal
guardianship.
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Employees
Not Eligible for Coverage
- Full-time temporary,
appointment types 2, 3, 5
- Part-time seasonal,
appointment type 6
- Intermittent,
appointment type 7
- Full-time interim
internal, appointment type 11, unless eligible prior to interim appointment
- Part-time interim
internal, appointment types 13
- Part-time interim
external, appointment type 14
- Student or college
intern classifications
- Employee on
uniformed service leave without pay (eligible at own expense)
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