Employee and Dependent Eligibility 

 

Employee Eligibility

Permanent, full-time employees are eligible for coverage on the first day of the month following 30 days of employment.

Dependents

  • Your legal spouse (common law marriages are not recognized);

  • Your child(ren): age 26, or older if they are primarily supported by you and are physically or mentally incapable of self support;

  • Your child(ren) up to age 26, regardless of whether they qualify as your tax dependent or their marital or student status.

  • Eligible children include your natural children, step-children who live with you at least six months of the year, legally adopted children, children for whom a Qualified Medical Child Support Order has been issued and children for whom you have legal guardianship.

 

Coordination of Benefits (COB) for Dependent Children
If your dependent child(ren) is covered by more than one health plan, the following "birthday" rule will determine which plan is primary (the plan that pays first):

  • The primary plan is the plan of the parent whose birth (month and date) falls earlier in the year.

  • The secondary plan (the plan that pays second) is the plan of the parent whose birthday falls later in the year.

  • If both parents have the same birthday, the plan that has covered the parent longer is the primary plan.

  • If the other plan does not have this "birthday" rule, but has the male/female rule; and if, as a result, the plans do not agree on the order of benefits, the rule in the other plan will determine the order of benefits.

  • A plan that does not coordinate with other plans is always the primary plan.

 

You may change your benefit elections during the annual Open Enrollment period or during the year if you experience a Qualifying Life Event. A Life Event change permits employees to make certain mid-year benefit changes consistent with the qualifying event.

Changes are Limited After Open Enrollment
The options you select during your enrollment period will be in effect from July 1, 2020 -  June 30, 2021. The only exception to this is if you have a qualifying event. Newly eligible dependents will be covered from the moment of the qualifying event as long as you enroll them as a dependent within 31 days from the life event change.

It is the employee's responsibility to notify HR of any life change that results in a loss of dependent eligibility. The employee may be responsible for any costs associated with misrepresentation. 

Please see the various life events below, or contact HR for more information.

Qualifying Life Events
A qualifying life event is a change in your personal life circumstances that may impact your eligibility or your dependent’s eligibility for benefits. Below are examples of qualifying life events. If one of these has happened to you, you may make changes to your plans, according to the stipulations below, within 31 days of the event. If you believe you have experienced a qualifying life event that is not listed here, please contact the Benefits Department at benefits@chattanooga.gov.

 

Marriage - within 31 days of the date of marriage, you may add your spouse to your existing medical, dental or vision coverage, or drop your coverage to go on your spouse's plan. You may also elect to change your medical FSA amount, and elect spouse coverage under our life insurance plan. You will need to complete the appropriate forms and provide a copy of your certified marriage certificate. You should also review your beneficiary designations for life insurance and retirement plans. 

Divorce - within 31 days of the date the divorce decree is signed, you may elect any coverage you are losing under your ex-spouse's plan. If you currently cover your ex-spouse, you must drop his or her coverage for medical, dental, vision and group term life, although you may continue to cover your children. You may also elect to change your medical FSA amount. You will need to complete the appropriate forms and provide a copy of the first and last pages of your certified divorce decree. You should also review your beneficiary designations for life insurance and retirement plans. Prior to the final decree, check with your attorney before dropping coverage.

Birth or adoption of a child, or having a child placed in your custody or guardianship through the court - within 31 days of the birth, adoption (official placement or final decree), or court order, you may add the child to your existing medical, dental or vision coverage, or drop your coverage to go on your spouse's plan. You may elect to change your medical FSA amount, and start or change a dependent care FSA. You may also elect child life insurance. You will need to complete the appropriate forms and provide a copy of the certified birth certificate, adoption placement order or decree, or court order. 

Death of a spouse or covered dependent 
- within 31 days of the death, you may elect any coverage you are losing under your spouse's plan. If you currently cover your deceased dependent, you must drop his or her coverage for medical, dental and vision although you may continue to cover the rest of your family. You may also elect to change your medical and dependent care FSA amounts. Again, you should review your beneficiary designations for life insurance and retirement plans. You will need to complete the appropriate forms and provide a copy of the certified death certificate. 

Becoming eligible (or losing eligibility) for Medicare, Medicaid or CHIP - within 31 days of the eligibility change, you may add or drop medical coverage for yourself or the applicable family member. In addition, your plan may permit you to add or drop coverage if you gain or lose eligibility for a Medicaid or CHIP premium assistance subsidy. You may also elect to change your medical FSA amount. You will need to complete the appropriate forms and provide a copy of the notification letter from Medicare, Medicaid or CHIP.

If your spouse's employment status changes causing a gain or loss of eligibility for coverage - within 31 days of the date of the status change (such as moving between full-time and part-time), you may elect medical, dental or vision coverage for yourself and your spouse and children, or drop your coverage to go on your spouse's plan. You may also elect to change your medical FSA amount. You will need to complete the appropriate forms and provide a letter from your spouse's employer on their letterhead verifying the effective date of change, listing all coverage being gained or lost, and listing all covered individuals. 

Change in spouse's employer causing gain or loss of coverage - within 31 days of the separation or the new hire date, you may elect medical, dental or vision coverage, or drop your coverage to go on your spouse's plan. You may also elect to change your medical FSA amount. You will need to complete the appropriate forms and provide a letter from your spouse's employer on their letterhead verifying the effective date of change, listing all coverage being gained or lost, and all covered individuals.

A change in residence to an area not covered by your current option - within 31 days of the move, you may change your Option only to a plan that covers the area to which you moved. 

If your spouse changes coverage during his/her employer's Open Enrollment period - within 31 days of the Open Enrollment, you may elect medical, dental or vision coverage, or drop your coverage to go on your spouse's plan. You will need to complete the appropriate forms and provide a letter from your spouse's employer on their letterhead verifying the effective date of change, listing all coverage being gained or lost, and all covered individuals.

If a Qualified Medical Child Support Order is established for a dependent 
- within 31 days of the order, you may add the child to your existing medical, dental or vision coverage or new coverage for yourself and child. You will need to complete the appropriate forms and provide a copy of the Qualified Medical Child Support Order. 

Enrollment in Marketplace coverage - after enrolling in Marketplace coverage, you must drop medical coverage through the City of Chattanooga. You may not drop or change dental, vision or medical FSA coverage.

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246 E. 11th Street, Suite 302 | Chattanooga, TN 37402 | 423-266-8306