Benefits Eligibility
Understanding the rules of benefits eligibility is important.
Please read the below information carefully and ensure that you understand when you can enroll yourself and/or your eligible dependents for coverage.
Eligibility requirements vary by school and employee class. Please contact your Human Resources/Benefits Department for specific eligibility requirements.
What to Know
| Benefit Event | Effective Date |
|---|---|
| New Hire | Benefit effective dates vary by school and employee class. Please contact your Human Resources/Benefits Department for specific new hire effective dates. |
| Annual Open Enrollment | Eligible employees may enroll, change or drop certain benefits annually during the SCIST annual Open Enrollment. |
| Special Enrollments / Qualifying Events | Members are only allowed to make mid-year election changes, including termination of coverage, during Special Enrollment periods as defined by the Health Insurance Portability and Accountability Act (HIPAA).
Employees must notify their employer within 30 days from the date of the event. |
| Dependents Eligible for Coverage | Eligibility Details |
|---|---|
| Spouses | Legally married spouse. |
| Dependent Children | Anthem Medical and Dental plans allow dependent coverage up to age 26. |
| OneAmerica Voluntary Term Life | Definition for Dependent and Disabled Dependent Disabled Dependent Questionnaire |
South Central Indiana School Trust reserves the right to require documentation of dependent eligibility, including but not limited to, birth and marriage certificates, adoption papers and guardianship documents.
Employees will be required to reimburse the Plan for any benefits paid by the Plan for a dependent at a time when the dependent did not satisfy these conditions. It is the employee’s responsibility to notify the Human Resources/Benefits Department if a dependent no longer qualifies, so that appropriate COBRA notices may be sent.
Special Enrollment
The Special Enrollments are allowed in two types of instances:
Life qualifying events for Employees, Spouses, and New Dependents would include:
- Marriage
- Birth
- Adoption, or placement for adoption
Loss of eligibility for coverage may occur when:
- Divorce or legal separation results in you losing coverage under your spouse’s health insurance;
- A dependent is no longer considered a “covered” dependent under a parent’s plan;
- Your spouse’s death leaves you without coverage under his or her plan;
- Your spouse’s employment ends, as does coverage under his employer’s health plan;
- Your employer reduces your work hours to the point where you are no longer covered by the health plan.
Contact your Human Resources / Benefits Department if you have specific questions regarding permitted special enrollment or qualifying events under HIPAA and your plan’s Section 125 plan.
