Spouse and Dependent Child(ren) Eligibility Requirements
Healthcare Reform now entitles children up to age 26 to participate in their parents’ health plan. The children can be married and do not have to live at home, be full time students, or be claimed on their parents’ taxes to be eligible for benefits. Eligibility ends on the last day of the month in which the child turns 26.
Tuition Remission and Tuition Exchange dependent eligibility can be found within TAP #13.
Who could be considered my legal dependent for Medical, Dental, Vision, and Dependent Life Insurance Benefits?
- Spouse means the legal spouse under the laws of the state where the marriage was performed provided that a state-issued marriage certificate is obtained. A copy of a certified marriage certificate will be required to obtain University sponsored benefits. Marriage certificates may be obtained from the county courthouse that issued the original certificate. Visit the Department of Health to access Pennsylvania Health Statistics and Vital Records. .
- Children under the age of 26, including:
- Natural child. Employees will be required to provide a copy of the front and back of the child’s certified birth certificate issued from the Department of Vital Statistics.
- Stepchild. Employees will be required to provide a copy of child’s certified birth certificate issued from the Department of Vital Statistics, a certified marriage certificate.
- Legally adopted child or child placed in anticipation for adoption. The term 'placed for adoption' means the assumption and retention by the employee of a legal obligation for total or partial support of the child in anticipation of adoption of the child and the child must be available for adoption and the legal adoption process must have commenced. Employees will be required to provide a copy of the court order specifying legal custody or a copy of the certified adoption papers, or a copy of the court order specifying legal custody, and a certified copy of the front and back of the revised birth certificate issued from the Department of Vital Statistics.
- Child who qualifies for benefits under a Qualified Medical Child Support Order. Employees will be required to provide a copy of the Support Order.
- Child for whom you have legal guardianship under a court order and the child lives with you. Employees will be required to provide a copy of the court order. Due to the expiration of legal guardianship at the age of 18, the University will permit the previously documented legal guardianship to be used as proof of eligibility purposes. The employee must be able to document legal guardianship for five continuous, consecutive years prior to the child turning 18 (i.e., between the ages of 13 to 18) to be considered eligible. Special consideration may be provided if an unusual circumstance resulted in a break in the guardianship between the ages of 13 to 18 if the employee can prove the guardianship was entered into for a minimum of ten years.
- Your mentally or physically disabled adult dependent children who are incapable of self sustaining employment by reason of the disability, live with you and who are primarily dependent on you for support and maintenance (you must provide appropriate documentation) provided that the child was disabled prior to age 26 and coverage under the plan commenced prior to the child's 26th birthday. The Plan Administrator may require proof of the child's total disability and dependency. The Plan Administrator reserves the right to have such dependent examined by a Physician of the Plan Administrator's choice, at the Plan's expense, to determine the existence of such incapacity.
Dependent Verification FAQs
If there are people either erroneously or fraudulently on our insurance plans, it can cost the University thousands of unnecessary dollars in both claims and administrative expense. Verifying each dependent’s eligibility is a way to contain insurance costs without asking employees to pay more to support the plan. Additional reasons include:
- Duquesne University has a responsibility under ERISA to ensure that plan dollars are used for the sole benefit of employees and their eligible dependents.
- Duquesne University bears a fiscal responsibility to the plan and the plan participants.
- Since the University offers pre-tax insurance premiums under Section 125 of the IRC, it is problematic to extend this tax shelter for dependents that are not eligible under the plan.
- Copy of front and back of the child’s birth certificate including the parent(s') names. The back of the form is only required if it contains further information.
- Copy of marriage certificate
- Copy of divorce decree
- Copy of Child Support Order
- Copy of Adoption or Legal Guardianship documentation
- Medical verification form completed by the child's doctor (required only for disabled dependents)
The University will request this information, if not already on file, in the following situations:
- Upon hire
- When there has been a Qualified Life Event
- When your dependent is applying for Tuition Remission or Tuition Exchange
Understand that your file may be audited at any time to determine the eligibility of yourself and/or any of your dependents.
If the child’s dependency status changes, it is your responsibility to notify the Benefits Office within 30 days. Duquesne University has a responsibility to ensure that only eligible expenses are paid from the Plan. This requirement is consistent with Internal Revenue Service (IRS) regulations that govern the operation of a qualified benefits plan. False and/or incomplete responses or statements may result in rescission of coverage and/or non-payment of claims for you or your eligible dependents as well as, discipline up to and including termination of employment.