Dependent Eligibility Guidelines

See Also: Required Documentation
See Also: Employee Eligibility Guidelines

Select a dependent type from the list below to review specific eligibility requirements. Review the Required Documentation page to find the specific documentation you are required to submit to the MI HR Service Center to add a dependent to your benefits, or, maintain their eligibility.

Life Events

To add or change eligible dependents due to a life event (e.g.: marriage, birth, divorce), call the MI HR Service Center as soon as possible, no later than 31 days following the life event. Do not wait until you have the official documentation.

Eligibility Exclusions

If you and your spouse, retired or actively employed, are both covered by State Group Insurance Plans, you may maintain separate coverage through your individual plans, or, enroll in one plan, with one of you listed as a dependent. If you choose to maintain separate coverage, your child(ren) can only be listed as a dependent on one plan, not both. This applies even if you are divorced.

An employee’s spouse, OEAI, and dependents are not eligible for coverage if he or she is an active duty member of the Armed Forces. Individuals who are called to active military duty are eligible for coverage under TRICARE, effective the date of active duty orders.

Legal Spouses - Legally recognized under Michigan law

An employee's legal spouse may be covered as a dependent under the health care, dental care, vision care, and dependent life insurance options as long as he or she is not also separately enrolled (at the same time) as a State employee or retiree in the same category of insurance (for example, State Health Plan or HMO).

Ex-spouses are not eligible to be listed as dependents. Contact the MI HR Service Center immediately to cancel an ex-spouse's enrollment(s). You must provide, within 31 days of the divorce, a copy of your divorce decree to the MI HR Service Center.

Your ex-spouse will be provided with an application to continue State group health, dental and vision insurance in his or her own name for up to 36 months by making direct premium payments pursuant to federal COBRA regulations. Conversion health care and life insurance policies are also available directly from the insurance plan administrators. COBRA and conversion options are explained in each benefit booklet.

Children

Eligible dependents may be enrolled in your health, dental, vision, and dependent life insurance plans. (OEAI and their dependents can only be enrolled in health plans.) Dependent children are eligible until the day before their 19th birthday. Your eligible child(ren) must be one of the following:

  • Child by birth, legal adoption, or legal guardianship. In the case of legal adoption, a child is eligible for coverage as of the date of placement. Placement occurs when you become legally obligated for the total or partial support of the child.
  • Step-child who lives with you at least 50% of the time and for whom your spouse must provide at least 50% of their support is eligible to receive health, dental, and vision coverage. All step-children are eligible for health coverage regardless of residence and support.
  • Foster child placed in your home by a state agency or the court.

Note: State-employed married or divorced employees carrying independent enrollments may cover their children in either parent's plan, as long as each child is only covered once.

If employees cannot agree which parent will cover the children, the parent whose birthday falls closest to the first of the calendar year will cover the dependent children.

Note: For a grandchild to be eligible, the parent of the grandchild must be a covered dependent AND, if the parent of the grandchild is between the ages 19 up to their 25th birthday, a student as well.

Student Eligibility

To enroll, or continue enrollment in dental and vision plans (health coverage continues automatically until the end of the month in which the dependent turns 26), a dependent must be your child by birth, legal adoption, or a step-child from the age of 19 up to their 25th birthday meeting the following criteria:

  • Enrolled and regularly attending an accredited educational institution (may have a lapse in attendance for only one term or semester per calendar year to be considered regularly attending); AND
  • You provide at least 50% of their support; AND
  • Unmarried.

Adult Children (Health Only)

Eligible children from the age of 19 through the end of the month of their 26th birthday may be enrolled in your health coverage regardless of marital, student status, or dependency upon you for support. Coverage does not extend to dental or vision plans or to their spouse or children. To be eligible for health coverage, a dependent must be: A child by birth, legal adoption, step-child or a dependent of an Other Eligible Adult Individual (OEAI). Coverage will terminate at the end of the month in which the dependent turns 26.

Continuing Coverage for Incapacitated Children

Your child who is unmarried and unable to sustain employment because of a developmental or physical disability can continue enrollment in health, dental, vision, and dependent life insurance beyond normal age limits if all the following conditions establishing incapacitated status are met:

  • Your child became incapacitated before reaching the age limit for the coverage (19 for dental and vision, 23 for dependent life, and the end of the month of turning 26 for health).
  • You have submitted documentation verifying your child’s incapacity within 31 days after the child reaches the age limit for termination of the coverage.
  • Your child continues to be incapacitated and chiefly dependent on you for support and maintenance.
  • Your coverage does not terminate for any other reason.

Providing documentation before an incapacitated child turns 19 is recommended to ensure continuing eligibility for all plans.

Ineligible Children

Children not meeting dependent eligibility requirements are not eligible.
Unless documentation is provided, claims payments for dental and vision insurance will end on: (1) the day before the dependent's 19th birthday (unless coverage is continued as outlined above), (2) the day before the dependent's 25th birthday (unless the dependent is incapacitated), (3) on the date your child marries, or (4) at the end of the pay period in which your dependent otherwise becomes ineligible (e.g. upon college graduation). Eligible children up to age 26 may be enrolled in your health insurance, regardless of marital or student status or dependency upon you for support.

Note: You must contact the MI HR Service Center immediately to cancel an ineligible child's enrollment(s).

Your ineligible child will be provided an application to continue coverages in his or her own name for up to 36 months by making direct premium payments pursuant to federal COBRA regulations. A conversion health insurance policy is also available directly from the insurance plan administrator. COBRA and conversion options are explained in each benefit booklet.

Other Eligible Adult Individuals (OEAI)

NEREs and employees currently represented by AFSCME, MCO, MSEA, UAW Local 6000, and SEIU Local 517 M may enroll one OEAI and their dependent(s) into a State of Michigan health plan only. Coverage does not extend to dental or vision plans for OEAIs or their dependents. To be considered eligible, the following criteria must be met:

  1. The employee does not have a spouse eligible for enrollment in the State of Michigan health plans.
  2. The OEAI is at least 18 years of age.
  3. The OEAI is not the employee’s spouse, child, parent, grandparent, foster parent, grandchild, parent-in-law, sibling, aunt, uncle, or cousin.
  4. The employee and OEAI have jointly shared the same regular and permanent residence for at least 12 continuous months, and continue to share a common residence other than as a tenant, boarder, renter, or employee.
  5. Dependent children of an OEAI may enroll in health insurance only under the same conditions that apply to dependent children of employees.

OEAI and dependent enrollment is only available upon initial hire or during the annual Insurance Open Enrollment (IOE) period. If the criteria for enrollment of an OEAI or the OEAI’s dependent child(ren) are no longer met, the employee must notify the MI HR Service Center within 14 calendar days. The employee will be responsible for paying taxes associated with enrolling an OEAI and the OEAI’s dependents. Review the OEAI tax implications document for additional tax information.

Dependent Life Insurance

Eligible dependents can include your spouse and/or unmarried children between the ages of 14 days up to their 23rd birthday for whom you provide at least 50% of their support. These dependents are not required to be enrolled in school. Your spouse is also eligible if they are not a State employee or State retiree. Eligible State of Michigan employees or retirees are enrolled in life insurance. If this coverage is maintained, you are not eligible to be covered as a spouse or dependent on another employee or retiree Dependent Life Insurance Plan.

Canceling Coverage

Immediately notify the MI HR Service Center to cancel your dependent coverage when he or she no longer meets the definition of an eligible individual. Ex-spouses are not eligible and must be removed from coverage effective the date of the divorce.