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Benefits Eligibility

Eligible Employees

Employees who are actively employed in a benefit-eligible, full-time position of the University are eligible to be enrolled in University-sponsored benefit plans (Postdoctoral Scholars and Fellows are eligible for the medical plan, but not eligible for benefits into retirement as outlined in policy HR54). Coverage becomes effective on the employee’s date of hire, provided the employee has completed the necessary enrollment through Workday no later than thirty-one days from their date of employment. A newly hired, benefit-eligible, full-time employee will automatically receive a Workday Inbox message concerning their new hire benefit elections on their date of hire.

An employee may cover their 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 they are already covered under a University-sponsored plan as an employee, retiree, or vice versa.

Eligible Dependents

Active employees and retirees 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 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 or retiree's University-sponsored medical, dental, vision and/or tuition discount plans.

Spouse Eligibility (including Same-Sex Spouses)

An employee may cover their 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 they are already covered under a University-sponsored plan as an employee, retiree, or vice versa.

Note: If a spouse who is enrolled in the employee's Penn State medical plan also has coverage available through their 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 not to marry.

No one is eligible to be covered as a spouse or dependent under a University-sponsored plan if they are 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 step-child (provided the PSU employee and step-child parent are currently married)

  • A child legally adopted

  • A child you have a Qualified Medical Child Support Order (QMSCO) for
  • 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 and have started the disability certification process with an appropriate benefit vendor prior to the end of the month that they turn age 26 (additional information on Disabled Dependent Eligibility is below)

Dependent children can be enrolled only under one parent’s plan if both parents are employed by the University and are eligible for benefits.

An adult-dependent child of an employee is eligible for coverage through the end of the month in which they turn age 26. Eligibility is regardless of whether they qualify as the employee’s tax dependent, 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.

After a dependent child is no longer eligible, that dependent child will receive information regarding the continuation of benefits under COBRA. 

Disabled Dependent Child Eligibility

A Workday notification is sent to the employee one (1) month prior to a dependent child turning age 26. The notification includes information concerning a dependent child who may be eligible to continue coverage if that dependent is physically or intellectually handicapped so as to be incapable of earning a living when coverage would normally terminate due to age. Follow the instructions provided in the notification regarding contacting the appropriate insurance carrier.

Once a disability certification is completed by the insurance carrier, communication will be provided to Penn State Employee Benefits for applicable coverage.

Newborn Eligibility

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).

Dependent Verification

Any employee who adds a dependent to their Penn State medical, dental, vision, and/or tuition benefit coverage will be required to provide documentation that demonstrates that the individual meets Penn State's eligibility criteria for the benefit being selected. If your dependent(s) has been removed from benefit coverage due to not successfully completing the dependent verification process, follow these instructions for having dependent coverage reinstated.

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.

Should an employee fail to verify a dependent on two separate attempts and attempt to add the dependent a third time to coverage, Penn State Employee Benefits will remove the dependent from coverage until the dependent verification process has been fully satisfied and approved. If the dependent has been removed by Penn State Employee Benefits, upon a dependent verification being satisfied and approved, the Benefits team will be able to assist with having the dependent added to coverage.

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:

  • Spouse
  • Children up to age 26 (regardless of whether they qualify 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, 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-qualifying life event changes with appropriate supporting documentation. 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. The effective date of a coverage change based on an IRS qualifying life event change will be the date that the life event occurred (for example, if a child is born on September 15, the effective date of coverage will be September 15), and in order to ensure a proper effective date is selected, supporting documentation regarding your event must be provided. Documentation may be a marriage certificate, a birth certificate, adoption documents, and/or loss of coverage information from a former employer or insurance company.

Employee or dependent coverage can be removed at any time 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, 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 the 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 affects 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.