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Indiana State Personnel Department

SPD > Benefits > Eligibility > Eligibility requirements to enroll Eligibility requirements to enroll

All active, full-time employees and elected or appointed officials are eligible to participate. For the purpose of benefits eligibility, full-time employees are defined as active employees whose regular work schedule is at least 37½ hours per week. Part-time, intermittent and hourly (temporary) employees who worked an average of thirty (30) or more hours per week over a 12-month review period would also be eligible for benefits.  Part-time, intermittent and hourly (temporary) employees working less than thirty (30) or more hours per week over a 12-month review period are not eligible for insurance or related benefits.

Dependents of eligible employees may be covered under the State’s benefit plans. In order for dependents to be covered, the employee must be covered. Dependents are defined as:

Spouse:  An individual to whom you are legally married. IC 31-11-8-5 provides: a marriage is void if the marriage is a common law marriage that was entered into after Jan. 1, 1958. Employees are not allowed to claim dependents based on common law marriages. An ex-spouse is not eligible for coverage even if court ordered.  

Children

Any children, step-children, foster children, legally adopted children of the employee or spouse, or children who reside in the employee’s home for whom the employee or spouse has been appointed legal guardian or awarded legal custody by a court, under the age of twenty-six (26). Such child shall remain a “dependent” for the entire calendar month during which he or she attains age twenty-six (26).

In the event a child:

i.) was defined as a “dependent”, prior to age 19, and
ii.) meets the following disability criteria, prior to age 19:

(I) is incapable of self-sustaining employment by reason of mental or physical disability,
(II) resides with the employee at least six (6) months of the year, and
(III) receives 50% of his or her financial support from the parent

such child’s eligibility for coverage shall continue, if satisfactory evidence of such disability and dependency is received by the State or its third party administrator in accordance with disabled dependent certification and recertification procedures. Eligibility for coverage of the “Dependent” will continue until the employee discontinues his coverage or the disability criteria is no longer met. A Dependent child of the employee who attained age 19 while covered under another Health Care policy and met the disability criteria specified above, is an eligible Dependent for enrollment so long as no break in Coverage longer than sixty-three (63) days has occurred immediately prior to enrollment. Proof of disability and prior coverage will be required. The plan requires periodic documentation from a physician after the child’s attainment of the limiting age.

Please Note: As of the 2016 benefit plan year, Anthem will administer the disabled dependent verification process. You must contact Anthem at least 45 days prior to the end of the month in which a disabled dependent turns 26 in order to initiate the eligibility review process and ensure that there is no lapse in coverage. Failure to contact Anthem will result in automatic removal. Anthem will request verification of disability for your dependent(s) in early 2016 in order to determine eligibility to continue coverage under your health plan(s).

Examples of persons NOT eligible for coverage as a dependent:

  • Ex-spouse
  • Live-in boyfriends or girlfriends
  • Parents or parents-in-law
  • Grandchildren (unless employee is the court-appointed legal guardian or custody)
  • Adults under guardianship of employee
  • Dependents older than the end of the month in which they turned 26 that are not disabled
  • Any other members of your household who do not meet the definition of an eligible dependent