Eligibility
Employees
Permanent
Employees who work in a permanent position and meet the following specifications will qualify for District-sponsored health insurance program (medical, dental, vision, and life insurance and Flexible Spending Accounts):
Certificated - 50%+ Full-Time Equivalency (FTE)
Classified - 4+ hour / day
Leadership - 4+ hour / day
Part-Time / Substitute / Hourly
Employees who meet the following specifications do not qualify to participate in the District-sponsored health insurance program:
Certificated - <50% Full-Time Equivalency (FTE) permanent
Classified - <4-hour / day permanent
Non-permanent or hourly
Substitutes
Contracted / Consultants
Dependents
Dependent Eligibility
An employee may add any / all eligible dependent(s) to his/her medical, dental, and/or vision coverage during the annual Open Enrollment or within 30 calendar days of a qualifying life event.
When adding a new dependent to their insurance coverage, employees must provide proof of dependent eligibility within 30 calendar days of the qualifying event, by the last school day in December (if added during Open Enrollment), or by the deadline date of an audit.
Please visit the Healthcare or Dependent Care FSA sections for dependent eligibility requirements.
Allowable Dependents
Accepted verification documentation must be submitted online through the Benefitfocus online eligibility system.
Lawful Spouse
- Employee cannot be enrolled as both a dependent & a subscriber under any of the District-sponsored health plans.
(See Combining Benefits Waiver for more information)
- Employee cannot be enrolled as both a dependent & a subscriber under any of the District-sponsored health plans.
Accepted Verification
1040 Tax Return from previous tax year
(If married more than 12 months)
- Front-page ONLY
- Redact income information
- Must indicate status confirming marriage
OR
Marriage Certificate
Domestic Partner
(As defined by the State of California)- Under California State Law, a Registered Domestic Partner now includes an opposite-sex individual age 18 and older.
- Employees will incur a tax liability for the cost of the Domestic Partner's coverage.
Accepted Verification
Official Domestic Partnership Registration
Child(ren)
Natural born
Adopted
Stepchild(ren)
of a Domestic Partner
of a Spouse
Court-ordered dependent
Disabled children over age 26 may qualify
Accepted Verification
Birth Certificate
Adoption Certificate
Court-ordered legal guardianship documents
(filed with the court)
Important Notice
Employees MUST submit adequate verification documentation for their dependent:
Within 30 calendar days of a Qualifying Life Event
By the last school day in December if the dependent was added during Open Enrollment
By the due date communicated to the employee if there is a Dependent Audit
If adequate verification documentation is not received by the aforementioned deadlines, then the following will occur:
The dependent will be ineligible for coverage and their enrollments will be retroactively terminated to the earliest date possible (in accordance with carrier contracts and IRS rules).
Any premiums paid by the District for the ineligible dependent's coverage will be charged to the employee as follows (whichever is less):
The difference between the amount the District paid for the dependent's coverage and the amount it should have paid for the corrected tier-level
OR
The cost of employee-only coverage on the plan plus a 2% administrative fee
Any services incurred after the retroactive termination date will be the employee's financial responsibility.
The dependent will not be offered COBRA continuation since they were determined "ineligible" to be on the plan.
Coverage Period
Start
Open Enrollment
Coverage begins effective January 1st.
Qualifying Events
Coverage begins first day of the month following the date of the qualifying life event.
Exceptions
Newborns of employees or newborns of an employee's covered spouse / domestic partner will automatically be covered for the first 30 days on the mother's medical plan. The employee MUST add the child through the online enrollment process through Benefitfocus and provide verification documentation no later than 30 days from the child's date of birth in order for the coverage to continue after the initial 30-day automatic coverage period.
Termination
Open Enrollment
Coverage continues through December 31. Plan selections (except Flexible Spending Accounts and medical waivers) will roll-over each year, unless there is a carrier / plan change or mandatory re-enrollment.
Qualifying Events
Coverage terminates effective the first day of the month following the date of the qualifying life event or the employee's last day in paid status.
Exceptions
If an employee is in paid status in June, then their benefits will continue through September 30th.
If an employee qualifies for a protected leave, their benefits will continue through the last day of the month for which the leave was approved.
Children who are disabled my qualify for continued coverage past age 26. The employee must contact the insurance carrier at their customer service number to complete the application process.