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Educated Choices: Are All My Dependents Eligible for Coverage?

Happy family of husband and wife with young daughter and son joining hands

Stanford Benefits often receives several questions regarding dependent eligibility. While the information is available on the Benefits & Rewards website and promoted during Open Enrollment and in the Welcome Center new hire orientation, we thought it would be helpful to summarize our most frequently asked questions.

If after reviewing these questions you require additional information, please contact the University HR Service Team.

The University HR Service Team

The University HR Service Team is an on-site team of benefits specialists available to assist employees and retirees with health, life, retirement other employment-related benefits. The University HR Service Team specialists are available Monday through Friday, 8 a.m.–5 p.m. PT, and are located on the Stanford Redwood City campus.

Contact a specialist by
Online Request Form and Live Chat:

  • Visit the Benefits website and log into My Benefits (upper right corner) to submit an online request or live chat with a specialist.

Phone:

  • 650-736-2985 (option 9)
  • Toll Free: (877) 905-2985 (option 9)

Whom can I cover on my Stanford benefits?

We are proud to extend benefits coverage to our employees’ eligible family members. This includes:

  • Spouse, same or opposite sex, if not legally separated
  • Registered domestic partner
  • Children, up to age 26:
    • Dependents

    • Stepchildren

    • Legally adopted children or children placed with you for adoption

    • Children for whom you are the legal guardian

    • Foster children

    • Unmarried children over the age limit if dependent on you for primary financial support and maintenance due to physical or mental disability; incapable of self-support; and the disability existed prior to age 19.

When adding dependents to your coverage, evidence must be submitted confirming eligibility. For a list of acceptable documentation you can use to certify any family members you cover under your benefits, visit the Benefits & Rewards website.

When may I update elections to add new dependents? 

You may update your benefits elections during the annual Open Enrollment period or during a qualified Life Event, such as a marriage, when you add a new child to your family or when you experience employment changes.

Who isn’t covered under my benefits and why?

The most common ineligible dependents are adult partners that are neither spouses nor registered domestic partners, including girlfriends/boyfriends, ex-spouses or those deemed to be “common law spouses.”  None of these extended family members are eligible to be covered under your benefits. The majority of Stanford’s medical plans and both dental plans are self-funded, which means Stanford is paying the claims, and covering ineligible dependents would directly impact our costs and the costs to our employees.

What happens if I enroll an ineligible dependent?

Enrolling an ineligible dependent on your benefits plan is not something that should be taken lightly. Not only is it considered fraudulent, but it’s a violation of the university Code of Conduct and can involve financial reparation.  If an ineligible dependent is discovered, it may result in the following consequences:

  • Repayment of the amount of claims paid for services for the ineligible dependent(s);
  • Repayment of any university-provided premium subsidy; and
  • Termination of employment

If you have questions regarding eligible dependents, refer to the Benefits & Rewards website or contact the University HR Service Team to consult with a specialist.

Is my ineligible dependent eligible for COBRA?

No.  COBRA is a Federal law that allows those enrolled through an employer sponsored medical, dental and vision plan to continue coverage in those plans after loss of eligibility. Since dependents in this specific circumstance are not eligible for university benefits they are not eligible for COBRA as they should not have been enrolled on university plans to begin with.  If an ineligible dependent is dropped from coverage COBRA will not be offered.

How may I correct my benefits elections if I have an ineligible dependent being covered?

If you are currently covering an ineligible dependent it is better to come forward and remove that individual from your benefits than to be discovered through an audit process or be contacted for the required documentation.  Contact the University HR Service Team to initiate the correction to your covered dependents.

 

Categories: 
Benefits & Rewards, Health