Eligible Dependents include legal spouses and children up to their 26th birthday. Upon marriage employees may add their spouse as a dependent within 60 days from the date of marriage for an effective date 1st of month following date of marriage.
Employees can obtain specific enrollment information and instructions from their human resource offices.
All submitted enrollment forms are reviewed for accuracy by the Office of Group Insurance before they are transmitted to our insurance carriers.
Once an employee has enrolled in a medical plan, they may decline coverage at any time, but they cannot change to another plan type until the next open enrollment period. Enrollment timeframes are contractually established; exceptions are not permitted under the contract.
Dependent Eligibility Verification (DEV)
Employees who enroll dependents in any of the State’s medical plans are required to provide appropriate documentation to meet the eligibility criteria for coverage. Cotiviti (formerly HMS Employer Solutions) conducts the verification process.
Following submission of the enrollment form, Cotiviti will contact the employee by email AND mail at the email address and mailing address listed on the enrollment form. The communication from Cotiviti will include step-by-step instructions to submit the appropriate documentation to verify a dependent’s eligibility, as well as a toll-free customer service number.
Ineligible Employees are those classified as a “seasonal employee” or a “part-time temporary” employee.
- Seasonal Employee. A position which the customary annual employment is six (6) months or less.
- Part-Time Temporary Employee. Expected, at the time of hire, to work twenty (20) hours or more per week but less than thirty (30) hours per week, and whose term of employment is not expected to exceed five (5) consecutive months.
A participant cannot be covered as both an employee and as a dependent on the State’s group plan. If an employee’s spouse is employed by any agency in the State’s group insurance program:
- One employee can waive medical coverage and be covered as a dependent spouse of the other
- Each employee can enroll in the self-only coverage
The same applies to dependent children. Dependent children may only be covered under one employee’s plan.
If you are an existing employee transferring employment from one agency to another you MUST re-enroll for all coverages. As part of your re-enrollment due to transferring, you may not change your benefit elections or elect previously declined coverages.
If you have no break in service, you will not be required to repeat the dependent eligibility verification for medical/dental coverages.
Dependent Verification FAQs
- A copy of your valid marriage certificate
- And one of the following:
- A copy of the front page of your most recent tax return confirming this dependent is your spouse
- A document dated within the last 60 days showing current relationship such as a recurring monthly household bill or statement of account. The document must list your spouse’s name, the date and your mailing address.
FOR NATURAL CHILDREN, STEPCHILDREN, ADOPTED CHILDREN (OR THOSE IN THE PROCESS OF ADOPTION) up to age 26:
- A copy of the child’s birth certificate or adoption certificate naming you or your spouse as the child’s parent (first and last names listed). Note, for newborns: A copy of the hospital birth certificate is acceptable provided it includes the names of the baby AND parent(s) AND has been signed by a hospital representative.
*Note for a stepchild: IF you are covering a stepchild you must also provide documentation of your current relationship to your spouse as requested above.
FOR CHILDREN who are legally dependent on you and for whom you maintain a PARENT – CHILD relationship:
- A copy of the front page of your current tax return confirm this child is your dependent, AND
- A copy of the court order naming you or your spouse as the child’s permanent legal guardian.
Failure to complete the verification process could result in an interruption in your dependent’s coverage. Claims incurred during months where your dependent was unverified due to failure to complete the full DEV will not be retroactively covered by the plan.
Cotiviti customer service representatives do not have the ability to make outbound calls. So if you are working with a representative on a specific issue, you will need to call them back to follow up.