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Home > Benefits > Medical Care Plans > Eligibility for Medical and Dental Care

Eligibility for Medical and Dental Plans

On this page: Eligibility | Eligibility for the HSA | Coverage Period | Continuation Opportunities

Eligibility and Enrollment Guidelines

Eligible Employees

Persons employed by Indiana University as full-time (75% FTE or greater) appointed Staff or Academic employees are eligible for medical and dental plan membership.

Note: J-1 Visa holders are only eligible for the Anthem PPO $500 Deductible medical plan due to the U.S. Department of State regulations regarding the maximum deductible limit of $500.

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, and generally for preferential state tax treatment as well depending on their state of residency.

**While Domestic partners and their children are eligible for IU-sponsored health care plan coverage, registered domestic partnerships, civil unions or similar formal relationships recognized under state law are not recognized by the IRS for preferential tax treatment.  The value of benefits provided to these individuals is added to the employee’s taxable income unless they can also be claimed as a tax exemption by the employee. 

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.

Domestic Partner Eligibility

IU-sponsored benefits are extended to registered same-sex domestic partners of Indiana University employees and associated children. In order to be eligible for IU-sponsored medical and dental plan enrollment, the individual must meet IU's criteria for a domestic partner and be registered by the employee with the University by submitting an Affidavit of Domestic Partnership and supporting documentation as required by the Affidavit. Children (biological, adopted, or qualified legal wards) of a registered domestic partner are eligible if they meet the same eligibility requirement as children of the employee or employee's spouse with regard to age, and/or disabled child eligibility.

Update: At the October 9, 2015, meeting of the Indiana University Board of Trustees, a resolution was passed discontinuing the domestic partner benefits program in light of the June 26, 2015, ruling of the United States Supreme Court giving same-sex couples a constitutional right to marry.

Click here for additional information about eligibility requirements and discontinuation of the domestic partner benefits program.

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. Failure to provide timely notice to the University can jeopardize COBRA benefits and result in additional cost to the employee. There may also be tax consequences when coverage is provided for ineligible dependents.

Eligibility for the Health Savings Account (HSA)

In order to be an eligible individual and qualify for an HSA, you must meet the following requirements:

No Other Medical Coverage requirement

In order to be eligible for tax-free contributions into an HSA, the IRS requires that you have no other medical coverage other than an IRS-qualified high deductible health plan. You are disqualified for tax-free contributions if:

You are still eligible to put tax-free contributions into your HSA if your spouse has other medical coverage.  However you cannot be covered on his/her medical or HRA/FSA/TSB plan and still be eligible to make tax-free contributions to your HSA account.

If you are ineligible to make  tax-free contributions, you can waive the HSA during Open Enrollment and still elect to be enrolled in the HDHP plan.

If you are ineligible to make tax-free contributions and still elect the HSA, you are responsible for reporting the ineligible HSA contributions on your annual tax return. Consulting a tax advisor about reporting ineligible contributions is advised.

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.

For information concerning continuation or conversion of health insurance as a qualified Indiana University Retiree, please refer to the information on Retiree status.


Page updated: 20 November 2015
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