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Home > Benefits > Medical Residents: Eligibility

Graduate Medical Education | Medical Residents
Eligibility and Enrollment Guidelines

On this page: Eligible Employees | Eligible Dependents | Coverage Period | Continuation Opportunities

Eligible Employees

Medical Residents appointed full time and part time but not less than 50% by the IUSM Office of Graduate Medical Education are eligible to receive health benefits, including medical and dental coverage.

Eligible Dependents

Dependents that are eligible for medical and dental care coverage are:

* A spouse means one by marriage, either opposite-sex or same-sex, legally entered into in one of the 50 states, the District of Columbia, or a U.S. territory or a foreign country.  Spouses qualify for preferential federal tax treatment of health care benefits, but may not qualify for preferential state tax treatment depending on their state of residency.  In order to correctly apply state taxes, a same-sex spouse must be registered with the University.

Disabled Child Eligibility

An employee's covered dependent child's medical coverage may be continued beyond the maximum age for coverage if the child meets the definition of "fully disabled." Proof that the child is fully disabled must be submitted in writing no later than 30 days prior to the date that dependent coverage would have ceased. The University has the right to require, at reasonable intervals, proof that the child remains fully disabled, is dependent on the employee for financial support, and otherwise satisfies the IRS criteria as a dependent for the purpose of excluding University contributions and the value of covered services from the employee's gross income.

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 (1) enroll for dependent coverage, or add the dependent to existing coverage by submitting applicable forms to the Human Resources office within 30 days after the child's birth (even if the employee is currently enrolled in Family or Employee/Child coverage) and (2) pay any contributions for the newborn child to continue as a covered dependent.

Adding and Dropping Dependents Mid-Year

Outside Open Enrollment, a dependent can be dropped or added only if the employee experiences an IRS-defined Change in Status, for example: marriage, divorce, or loss of coverage under the spouse's health plan. Changes must be made within 30 days of the date of the Change in Status. After that time, the employee must wait until the next Open Enrollment.

> Family Status Change

Dual Coverage

No individual may be eligible for benefits under more than one IU-sponsored health plan. Ineligible coverage includes an individual covered as:

An Employee is not eligible as the Spouse of an Employee in a lower premium band.

Duty to Notify of Ineligibility

The employee is responsible for notifying the University in writing of any change that affects the employee's dependent eligibility, for example, marriage or divorce. A medical or dental plan enrollee ceases to be a covered dependent on the date the enrollee no longer meets the definition of a dependent, regardless of when notice is given to the University. The employee is responsible for notifying the University in writing within 30 days to initiate any reduction in premium contribution.


Coverage Period

Employee coverage becomes effective on the first day of active employment as an eligible employee, if the employee enrolls within 30 days of such employment. Coverage is not activated until the employee's health plan enrollment form is received and processed. Until health plan coverage is activated the employee may need to pay health care costs out-of-pocket and file claims once coverage is activated.

In the event that an employee is placed on leave at the time of initial employment, the employee's coverage will become effective on the first day of active employment.

Employee coverage will terminate when:

Dependent coverage ends on the date the dependent no longer meets the criteria for dependent eligibility.


Continuation Opportunities

For information concerning opportunities for continuation of coverage in the event of lost health care coverage due to a change in employment, or the loss by a spouse or dependent of group health care coverage under an Indiana University sponsored health care plan due to changes in family status, please refer to the information on COBRA.


Page updated: 28 January 2016
Contact Benefits: • (812) 855-2172

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