Benefits Eligiblity / Dependent Eligibility

To be eligible to participate in the USG Benefit Platform, you must be a regularly employed KSU faculty or staff member working at least 30 or more hours per week.

Eligible Dependents for Medical Plan Coverage:

Eligible dependents for Medical Plan coverage are defined as:

  • Legal spouse (does not include common law spouse);
  • Natural and adopted children up to age 26;
  • Children who have been placed for adoption in connection with assumption by the person of a legal obligation for the total or partial support of a child in anticipation of the legal adoption of such child;
  • Step-children up to age 26
  • Children up to age 26 for whom the covered employee is the permanent legal guardian if a court has named the employee as the child’s permanent guardian;
  • Unmarried, disabled children beyond age 26 if:
    • They are unable to support themselves; and
    • They depend on the employee for support; and
    • The condition existed prior to age 26; and
    • Proof of incapacity is furnished within 30 days of the dependent child’s 26th birthday

 

Eligible Dependents for all other benefits plans:

In order to cover an eligible dependent, you must provide documentation verifying your dependent meets the definition of eligible dependent.

  • Legal Spouse
  • Unmarried, natural and adopted children under age 26;
  • Unmarried step children under age 26 who depend on the employee for support and maintenance and who live with the employee in a normal parent‐child relationship; 
  • Children for whom the covered employee is the permanent legal guardian if:
    • A court has named the employee as the child’s permanent guardian; and
    • The child lives in the employee’s home in a normal parent‐child relationship; and
    • The child is dependent on the employee for support.
  • Unmarried, disabled children beyond the age limit if:
    • They are unable to support themselves; and
    • They depend on the employee for support; and
    • The condition existed prior to age 26; and
    • Proof of incapacity is furnished within 31 days of the child’s 26th birthday.

Dependent Documentation Required:

To enroll your Spouse, you must provide copies of 2 forms of verification.

  • A copy of your marriage certificate AND
  • A copy of the front page of one of your last two year’s filed federal tax return confirming this dependent as a spouse, OR documentation dated within the last 6 months establishing current relationship status such as a joint household bill, joint bank/credit account, joint mortgage or lease, listing you and your spouse’s names OR documentation dated within the last 6 months establishing current residency. You may blacken out any financial information.
If you were recently married, you may not have federal tax returns or joint bills. Therefore, we will accept a copy of your marriage certificate. However, you may be required to provide additional documentation at a later date.
 
To enroll your dependent children up to age 26, you must provide the following documents:
  • A copy of your child’s birth certificate, naming you or your spouse as the child’s parent, or appropriate court order / adoption decree naming you or your spouse as the child’s legal guardian.
If your dependent is your stepchild, you must also provide:
  • A copy of your marriage certificate as proof of the dependent’s relationship to the employee
If your dependent is disabled and over age 26, you must also provide:
  • A copy of the front page of one of your last two year’s filed federal tax return confirming showing that you claimed this dependent. You may blacken out any financial information
  • Proof of incapacity;   
Dependents turning Age 26:
Once your dependent turns age 26, they are no longer eligible to remain covered under the University System of Georgia Healthcare Plan. As a result, his/her coverage will end as of the day they turn age 26. The system will automatically remove them from your plan(s) and mail a COBRA packet to notify them of their COBRA enrollment rights.

Family Status Changes and Qualifying Life Events

Certain life occurrences may necessitate mid-year changes in benefits status or enrollment. An employee who experiences one of the occurrences listed below can make benefits enrollment changes within 30 days of the event.

Family status changes can be initiated through the OneUSG Portal. Supporting documentation (marriage certificate, birth certificate, proof of loss, etc.) must be provided for the change to be approved. Employees who do not initiate Family Status Changes within the 30 day window must wait until the annual Benefits Open Enrollment Period to make changes.

Some examples of qualifying events include:

  • A change in your marital status; 
    The birth or adoption of a child (including stepchildren and legally placed foster children);
  • The death of a covered dependent;
  • A change in the employment status of a covered member, his/her spouse, or his/her covered dependent(s), that affects eligibility for coverage under a cafeteria or other qualified healthcare plan;
  • The loss of eligibility status by a covered dependent;
  • A campus approved leave of absence without pay (maximum of 12 months);
    You and/or your spouse being called to full-time active military service/duty;
  • Losing or gaining healthcare coverage eligibility under Medicare or Medicaid;
  • A change in residence to a location outside of a healthcare plan’s service area;
  • Healthcare plan election choices made by spouses with different employers in which the employers have a different healthcare plan years
  • A dependent who loses coverage due to a Family Status Change will be offered continuation of benefits under COBRA. Employees who experience a family status change may also wish to update their tax withholding status.

Effective Dates
Coverage for a newborn becomes effective retroactively to the date of the birth.  Employee will be charged the full month of premium regardless of the date the coverage becomes effective.  Premiums are not pro-rated.

Coverage becomes effective the first of the month following a marriages, divorces, dependents(spouse or children) losing or gaining coverage.