Benefits Eligibility and Dependent Information
Employees who are actively employed in the regular, full-time service of the University are eligible to be enrolled in University-sponsored benefit plans. Coverage becomes effective on the employee’s date of hire, provided the employee has completed the necessary enrollment through Worklion no later than thirty-one days from his/her date of employment.
Active employees who are participating in University-sponsored benefit plans have the ability to extend coverage to eligible dependents.
Dependent coverage cannot be elected unless the employee is covered under the plan being selected. Dependents are eligible for coverage on the day the employee’s coverage begins, or at the time they become eligible dependents due to an IRS Qualifying Life Event.
Individuals who are considered to be eligible dependents of University-sponsored benefits plans are a spouse (unless legally separated or divorced), dependent children, and children under a Qualified Medical Child Support Order (QMCSO).
Penn State requires dependent verification for all dependents who are listed on an employee’s University-sponsored medical, dental, vision and/or tuition discount plans.
Spouse Eligibility (including Same-Sex Spouses)
University-sponsored benefits are extended to spouses of Penn state employees.
An employee may cover his/her dependent spouse even if that individual is also an employee of the University. However, no one is eligible to be covered as a spouse or dependent under a University-sponsored plan if he/she already is covered as an employee under a University-sponsored plan or vice versa.
Note: If a spouse who is enrolled in the employee's Penn State medical plan also has coverage available through his/her own employer, the Penn State employee will be assessed a monthly surcharge to cover that person on the employee's Penn State medical plan. For more information see Spousal Insurance Surcharge.
Same-Sex Domestic Partner Eligibility
Effective 07/01/2015, Penn State will no longer be offering benefits to new employees’ same-sex domestic partners and the children of those individuals. This change is in response to the Supreme Court ruling that legalizes same-sex marriage in all 50 states, as well as to remain consistent with how the University handles benefits for opposite-sex domestic partners who choose to not marry.
No one is eligible to be covered as a spouse, or dependent, under a University-sponsored plan if he/she is already covered as an employee under a university-sponsored plan, or vice-versa.
Common-Law Spouse Eligibility
The state of Pennsylvania requires a state license to wed, and therefore does not recognize common-law marriage within the state. Because of this ruling, common-law spouses are not eligible for Penn State benefits. Employees who possess common-law marriage documentation from a state which recognizes common-law marriage should contact HR services to discuss options for benefits eligibility.
Dependent Child Eligibility
Dependent children are defined as:
A natural child
A child legally adopted
As of 01/01/2017; A child for whom you have legal guardianship over
Or physically or intellectually disabled children who are incapable of self-sustaining employment, regardless of age, provided they are covered prior to the maximum age otherwise applicable (additional information on Disabled Dependent Eligibility is below)
An adult dependent child of an employee is eligible for coverage up to the age of 26. Eligibility is regardless of whether he/she qualifies as the employee’s tax dependent, is a full-time student or is married.
Note: If the adult dependent child of the employee is married, only the adult dependent child of the employee will be eligible for coverage.
Notification is sent to the employee 30 days prior to a dependent child turning age 26. This notification includes information concerning a dependent child who may be eligible to continue coverage if that dependent is mentally or physically handicapped, so as to be incapable of earning a living when coverage would normally terminate due to age. After a dependent child is no longer eligible, that dependent child will receive information from regarding continuation of benefits under COBRA.
Disabled Dependent Child Eligibility
If a dependent child is physically or intellectually disabled and is incapable of self-sustaining employment, regardless of age, that individual may be certified as a disabled dependent for medical coverage beyond the age of 26. In the event that a dependent is still in a disabled status as his/her 26th birthday approaches, please contact Aetna for assistance in certifying that dependent as disabled.
The disability certification will be completed by the medical insurance carrier and communicated to the Penn State Employee Benefits for applicable coverage.
The newborn child of a covered employee will be covered immediately from birth for the first 31 days if (1) the employee was covered under the Plan on the child's date of birth, and (2) the newborn meets the definition of eligible dependent. Notice to the Plan Administrator does not add the newborn to the employee's medical or dental plan. In order for the newborn to have coverage beyond the first 31 days, the employee must add the dependent to existing coverage via the WorkLion within 31 days after the child's birth (even if the employee is currently enrolled in Family or Employee/Child coverage).
Any employee who adds a dependent to his or her Penn State medical, dental, vision and/or tuition benefit coverage will be required to provide documentation which demonstrates that the individual meets Penn State's eligibility criteria for the benefit being selected.
In addition, the verification process is required for any existing faculty and staff who add dependents either during the annual benefits open enrollment period or when experiencing a qualifying event, such as marriage, or the birth or adoption of a child.
If an employee leaves University employment and is later re-hired with the University, dependent verification will be required again for any dependent(s) added to University-sponsored medical, dental, vision, and/or tuition discount plans due to the re-hire.
Who is an eligible dependent?
For Health, Dental and Vision plans:
- Children up to age 26 (regardless of whether he/she qualifies as the employee’s tax dependent, is a full-time student, or is married). An eligible child is defined as follows: a natural child, a step-child, a legally adopted child, a child for whom you have legal guardianship over, or a disabled child incapable of self-sustaining employment enrolled prior to age 26.
For the Tuition Discount:
- Please refer to policy HR 37, Grant-In-Aid for Dependents for full policy language
Adding and Removing Employee or Dependents Mid-Year
Outside Open Enrollment, employee coverage or dependent coverage can be added only if the employee experiences an IRS-defined life event changes. Changes must be made in Workday via the WorkLion portal within 31 days of the date of the life event change. After that time, the employee must wait until the next Open Enrollment.
Employee or dependent coverage can be removed at anytime throughout the year without a life event change. Though, if you remove coverage and later decide that you want Penn State coverage, the above guidance for adding coverage would be applied.
The following is a summarized list of IRS-defined life event changes:
- Employee's legal marital status changes, due to marriage, divorce, legal separation, or the death of a spouse;
- A change in the number of dependents you cover, due to birth, legal adoption, a Qualified Medical Child Support Order (QMCSO), or death;
- Changes in employment status of the employee, such as moving from full-time to part-time employment;
- Changes in employment status of a spouse, which can include the ending of their employment, new or different working hours resulting in a change of their employer-sponsored benefits, a benefit change due to a strike, a benefit change for them due to a change in work hours, or if they begin an unpaid leave of absence resulting in a change of benefits;
- A dependent who becomes ineligible for the benefit plan due to age, student status, or by obtaining coverage via other means
Duty to Notify of Ineligibility
The employee is responsible for making the appropriate updates in Workday for any change that affect the employee's dependent eligibility, for example, marriage or divorce. An enrollee ceases to be a covered dependent of all employee benefit plans on the date the enrollee no longer meets the definition of a dependent, regardless of when notice is given to the University. Covering a dependent who does not meet the eligibility criteria, intentionally or unintentionally, may result in disciplinary action, up to and including termination of employment.