Eligibility

Primary Member
Dependents
Caution About Divorce Proceedings
DHS-Directed Dependent Additions (National Medical Support Notice)
Surviving Dependents
More Information About Eligibility

Primary Member 

An education employee must be eligible to participate in the Teachers’ Retirement System and work a minimum of four hours per day or 20 hours per week.

A local government employee must be employed in a position requiring a minimum of 1,000 hours per year and not listed as seasonal or temporary employee.

Other persons who are elected by popular vote, or employees who are on approved leave without pay status (not to exceed 24 months).  (See OSEEGIB Rules 360:10-1-2)

Coverage for a new employee becomes effective the first day of the month following their employment date or the date they become eligible following any employer probationary period, if applicable. There is a 30-day window following the employment or eligibility date when an employee can make benefit changes. These changes are effective the first day of the month following the date the change is made.

Dependents 

An employee must be enrolled in coverage for their dependents to be enrolled in that same coverage. If dependent coverage is selected, all eligible dependents, including newborns, must be covered.

Spouse

An employee can add their spouse to coverage at initial enrollment, within 30 days of a qualifying event, or during the annual Option Period. If the spouse is not added during initial enrollment, they can be added only within 30 days of a qualifying event, or during the next annual Option Period. A spouse can be added to coverage as long as a legal separation has not been filed.

• Common-law spouse: OSEEGIB recognizes common-law marriages. An employee’s common-law spouse must sign the “Common-Law Spouse Certification” on the Insurance Enrollment Form or Insurance Change Form. Once a common-law marriage is publicly declared, it can be dissolved only through a legal divorce.
• Same-sex domestic partnerships or marriages are not recognized by Oklahoma law.

Excluding a Spouse From Coverage

An employee can exclude their spouse from coverage. Their spouse must sign the “Spouse Exclusion Certification” section of the appropriate form. A spouse can be excluded only from health and dental coverage using this form. To exclude a spouse from vision while covering dependent children under vision, the spouse must have other group vision coverage.

Dependent Children

An employee can add their eligible dependents during initial enrollment, within 30 days of a qualifying event, or during the annual Option Period. If dependents are not added during initial enrollment, they can be added only within 30 days of a qualifying event, or during the next annual Option Period. An employee is not required to cover their dependent children; however, if coverage is elected for dependent children, certain rules apply.

• Dependents can be enrolled in only the same coverage as the employee; i.e., to enroll dependents in dental coverage, the employee must also be enrolled in dental coverage.
• All eligible dependents must be covered unless they have other group health coverage, or are eligible for Indian or military benefits, or they are married.
• If both parents are primary members under OSEEGIB, dependent children can be covered under only one parent, except in the case of Dependent Life insurance.

Eligible dependent children include an employee's:

• Daughter, son, stepdaughter, stepson, eligible foster child, adopted child, or child legally placed with the employee for adoption up to age 26, whether married or unmarried.
• Dependent, regardless of age, who is incapable of self-support due to a disability that was diagnosed prior to age 26. A Disabled Dependent Assessment Form must be submitted at least 30 days prior to the dependent’s 26 birthday. The Disabled Dependent Assessment Form must be approved by OSEEGIB before coverage begins. For additional information, refer to Special Rules for Disabled Children later on this page.
• Other unmarried dependent children up to age 26, upon completion and approval of an Application for Coverage for Other Dependent Children. Other dependents include grandchildren, nieces, nephews, and other children. Guardianship papers or a tax return showing dependency can be provided in lieu of the application.
• Special rules for for newborn coverage
• Newborn with enrollment: An employee must add their infant within 30 days of the birth and pay premiums for the month of the child’s birth. A separate deductible may apply to the newborn, depending on the employee’s plan. If an employee does not enroll their infant within 30 days, the child cannot be added until the next annual Option Period. The newborn’s Social Security number is not required at the time of initial enrollment, but must be provided when it is received from the Social Security Administration.
• Newborn without enrollment: A newborn has limited coverage without enrollment. Newborn benefits vary for each plan. To verify benefits, contact each plan directly.
  • • CommunityCare - A newborn is covered for 31 days without an additional premium.
    • GlobalHealth - A newborn is covered for 31 days without an additional premium.
    • HealthChoice - A newborn is covered for a routine birth and well-baby care for the first 48 hours following a vaginal delivery or the first 96 hours following a C-section delivery without an additional premium. A separate calendar year deductible and coinsurance applies. The employee is responsible for any charges over the limited benefits described above.
    • UnitedHealthcare - A newborn is covered for 31 days without an additional premium.

Excluding Dependents From Coverage

An employee can exclude eligible dependents from coverage if they:

• Are covered under another group insurance plan
• Are eligible for Indian or military benefits
• Are married
• Do not reside with the member
• Are not financially dependent on the member

Effective Dates of Coverage for Dependent Children

Typically, the effective date of coverage is the first day of the month following enrollment or on January 1 when enrollment occurs during Option Period. Exceptions include:

• Newborn - the effective date of coverage can be either the first day of the month of birth or the first day of the following month
• Adoption - the effective date of coverage is the first day of the month the employee gains physical custody of the child or the first day of the following month
• Legal guardianship - the effective date of coverage is the first day of the month following the date the employee gains physical custody of the child
• Court order - the effective date is dictated by the court

Special Rules for Disabled Dependents

Disabled dependent children must be incapable of self-support because of mental or physical incapacity that existed prior to age 26. These dependents are eligible to continue benefits as long as they meet all eligibility rules. To continue benefits on a disabled dependent beyond age 25, the primary member must:

• Submit a copy of their most recent federal and/or state tax returns to provide proof of dependent status.
• Complete and submit an application/assessment form. This form is known as a Disabled Dependent Assessment Form. A form must be completed for each child and returned to OSEEGIB within the time frames described below:
  • New employees must submit the application/assessment form within 30 days of enrollment.
  • Current employees must submit the application/assessment form at least 30 days prior to the dependent’s 26th birthday.
  • Former employees who continued coverage on a disabled dependent at retirement must submit the application/assessment form a least 30 days prior to the dependent’s 26th birthday.
• The Disabled Dependent Assessment Form must be approved by OSEEGIB before coverage begins.

Note: If the application/assessment form is not received within the designated time frame, continuation of coverage is denied.

Caution About Divorce Proceedings 

Oklahoma law prohibits a member from dropping a spouse or dependents in anticipation of a divorce or legal separation, even during the annual Option Period. If an employee is in the process of separation or divorce, it is important they contact their legal counsel for advice before making any changes to their coverage.  (See 43 O.S. § 110)

If an employee is court ordered to provide health insurance for a former spouse, please note the former spouse is not an eligible OSEEGIB dependent and is not allowed coverage under the employee. If the former spouse was covered by the employee as a dependent at the time of the final divorce decree, the spouse is eligible for coverage under COBRA. If the former spouse was not covered at the time of the final decree, they are not eligible for coverage through OSEEGIB.

DHS-Directed Dependent Additions (National Medical Support Notice) 

You may receive a document called a National Medical Support Notice. This document is a court order requiring an employee to insure one or more of their children.

The parts included in this notice are:

• Part A - Notice to Withhold for Health Care Coverage (your part), and
• Part B - Medical Support Notice to Plan Administrator (OSEEGIB’s part).

You are required to complete the Employer Response in Part A of the notice and return it to the issuing agency. You are also required to forward Part B to OSEEGIB as the plan administrator. Please do not complete Part B yourself. Depending on how the notice is worded, the employee may be required to add additional benefits or change carriers when they receive  the National Medical Support Notice. Please do not make any changes to the employee's coverage via the web application in response to this notice.

Our Web Support Unit handles all National Medical Support Notices, so if you have questions, you can call 1-405-717-8707 or toll-free 1-800-543-6044, ext. 8707. When you forward Part B to OSEEGIB, we will make the appropriate changes to the employee's coverage and contact you to review them. All changes to coverage will be effective the first day of the month following receipt of the National Medical Support Notice.

Please forward Part B to:

Oklahoma State and Education Employees Group Insurance Board
P.O. Box 58010
Oklahoma City, OK 73157-8010

Surviving Dependents 

In the event of an employee’s death, you need to complete an Insurance Termination Form for the employee and inform OSEEGIB of the death.  To continue their coverage, the surviving spouse and dependents have 60 days following the death to complete and return the Surviving Spouse and Dependent Election Form. Coverage is effective the first day of the month following the employee’s death.

• A surviving spouse is eligible to continue insurance coverage as long as premiums are paid.
• Surviving dependent children are eligible to continue insurance coverage until age 26.
• Disabled dependent children are eligible to continue coverage as long as they meet the OSEEGIB definition of a disabled dependent.

Note: A surviving spouse is billed the primary member rate and dependents are billed the appropriate dependent rate. When a parent is not listed as the primary member, surviving dependent children are each insured under separate accounts and billed the child premium.

COBRA continuation of coverage is available to dependent children who lose eligibility.

Premium Notices are sent to the survivors’ addresses, and premiums must be paid through the last day of active coverage.

If a survivor is age 65 or older, Medicare becomes the primary insurer and they must enroll in a Medicare supplement plan.

More Information About Eligibility 

An employee's parents cannot be covered as dependents; however, adult siblings may be eligible if they are under age 26, unmarried, reside with the employee, and are financially dependent on the employee. The employee must complete an Application for Coverage for Other Dependent Children to request coverage.

Dependents do not have to be enrolled in a health plan to be eligible for dental coverage; however, they must be enrolled in the same dental plan as the employee.

If other eligible dependents are covered under dental, vision, and/or life insurance, a newborn must also be added to coverage. When an employee adds a newborn, it is also a qualifying event to add other eligible dependents.

The fact that an employee is eligible for insurance coverage may not mean the employer pays anything toward that coverage.