Spouse/Domestic Partner/Dependent – Plan Options

Affordable Care Act

Information on the Affordable Care Act health insurance options is available at www.healthcare.gov.

What to do now:

Start by making a list of things that will be important in your coverage decision, for example:

  • Know how your current health insurance plan (if any) works, whether it will continue, and when it will renew.
  • Know about your insurance coverage in the local area, since many health insurance plans provide more limited benefits when you are away from your home or “out-of-area.”
  • When purchasing a health insurance plan, you should not consider premium cost alone. Plans with higher out-of-pocket expenses may have lower premiums, but a high deductible and high member coinsurance can make members reluctant or financially unable to receive necessary medical treatment.

 

Family Health Coverage

The health insurance Marketplace is a way to find health coverage for your family that fits your budget and meets their needs.

Health plans in the Marketplace offers the same set of essential health benefits, including doctor visits, preventive care, hospitalization, prescriptions, and more.

Get a break on costs: When you use the Marketplace you may be able to get a tax credit to lower costs on your monthly premiums and out-of-pocket costs. When you apply, you’ll find out how much you can save. Most people who apply will qualify for some kind of savings.

The Supreme Court confirmed that if you qualify, you can receive financial assistance, including a premium tax credit, to make coverage more affordable no matter where you live. On average, consumers enrolled in the Marketplace are receiving $3,260 per year in tax credits, or $272 each month. About 8 in 10 consumers could find coverage for $100 or less with tax credits through the Marketplace.

As part of the Affordable Care Act (ACA), an online Health Insurance Marketplace was launched in 2013. This is a way for individuals and families who meet certain income requirements to buy private health insurance plans. Four levels of plan are offered through the Marketplace. The plans vary from each other based on the amount of out-of-pocket medical expenses that are covered. For example, the lowest cost “Bronze” plans only cover 60% of medical expenses, “Silver” plans cover 70%, “Gold” plans cover 80%, while the highest tier “Platinum” plans cover 90% of medical expenses. Individuals may be eligible for a subsidy (depending on their income) that will reduce the cost of a Marketplace plan.

Visit HealthCare.gov or call the BJC Marketplace Navigator for personal assistants at 1-855-747-4994 for an appointment to maximize your benefits.

You may also be eligible for Medicaid or your family could be eligible for the Children’s Health Program (CHIP). There is no deadline to enroll so if you qualify, it’s never too late to get coverage. Medicaid and CHIP provide free or low-cost health coverage to millions of Americans, including some low-income people, families and children.

WUSM Student Health Spouse/Domestic Partner/Dependent – Enrollment

  • Not eligible for coverage through school or employer
  • Denied coverage in the Marketplace.

Students may enroll their eligible dependents in the program by paying an additional Student Health Services access fee. The Student Health Services access fee for all covered dependents must be paid directly to Student Health Services at the time of enrollment. Enrollment application must be made through the Student Health Services office.

Students may enroll dependents into this program only at the following times:

  • At the time the student enrolls in WUSM (at student matriculation), or
  • Within thirty-one (31) days of a qualifying event, as defined below.

Benefits Dependent Enrollment

Benifits Dependent Verification Affidavit

Domestic Partner Verification

Student Health Access Fee

The Student Health Services access fee for all covered dependents must be paid directly to Student Health Services, with the first month due at the time of enrollment. The students’ responsibility for eligible dependents:

  • Spouse or domestic partner: $4,177 per year ($348 per month);
  • Covered child: $1,842 per year ($153.50 per month) per child.

Enrollment application must be made through Student Health Services, 4525 Scott Ave, Suite 3420.

Student contributions and access fees are subject to review, and Washington University reserves the right to change student contribution or access fee amounts at any time upon 60 days’ notice. You can obtain current contribution rates by calling Student Health Services.

Who is eligible?

An eligible dependent is:

  • Spouse, domestic partner or dependent child of  a student (as defined below) who resides with the student and who is not eligible for coverage through his/her school or employer.
  • Spouse, defined as an individual to whom the student is legally married, or a Domestic Partner, defined as an individual of the same or opposite sex with whom the student has established a domestic partnership. A domestic partnership is a relationship between a student and one other person of the same or opposite sex. Both persons must:
  • not be so closely related that marriage would otherwise be prohibited;
  • not be legally married to, or the domestic partner of, another person under either statutory or common law;
  • be at least 18 years old;
  • live together and share the common necessities of life;
  • be mentally competent to enter into a contract; and
  • be financially interdependent.

In order to cover a domestic partner, a student must complete a domestic partner affidavit.

Dependent child(ren)

Dependent child(ren), defined as the student’s child, the spouse’s child, or the domestic partner’s child, as long as the child:

  • is under 19 years of age and dependent upon the student for support and maintenance; and
  • is the student’s biological child, stepchild, legally adopted child, or a child placed with the student for adoption, or a child for whom the student and/or his or her spouse or domestic partner is the legal guardian; and
  • resides with the student 100% of the time during the policy year (full custody); and
  • is not eligible for coverage as a dependent of someone other than the student, provided that this requirement shall not apply if both parents are covered by the WUSM program; and
  • does not qualify for coverage through Medicaid and the Children’s Health Insurance program.
  • If a student elects to have a dependent child covered by this health program, then all eligible dependent children of the student must be covered by this health program, and the appropriate health service access fee for each covered dependent child must be paid.
  • All dependents (spouses, domestic partners, and dependent children) must provide proof of prior continuous creditable coverage over the six months immediately preceding coverage through the WUSM program.

Required documentation

Appropriate documentation for each family member enrolled in the student’s plan is required.  Documentation is required only for initial enrollment (unless there is a change in your dependent’s information or are enrolling a dependent due to a life changing event).

  • Spouse: marriage certificate, proof of joint residency
  • Qualified same-sex partner: proof of joint residency
  • Dependent children: birth certificate, legal documentation of adoption or guardianship, proof of residency
  • Other health insurance coverage ending: Copy of insurance termination of coverage letter

Coverage dates (begin/end dates)

Benefits are payable under this program only for those covered medical expenses incurred while the Program is in effect.  No benefits are payable for expenses incurred after the date the benefits terminate. This program terminates for all covered dependents once the student is no longer covered or if the Student Health Services access fee for covered dependents has not been received.  There will be a thirty-one (31) day grace period for late payment of the access fee, after which time, coverage for the student’s dependents will be terminated. If dependent coverage is terminated due to lack of sufficient payment, coverage for any dependents of that student will not be allowed at any time in the future.

If a student elects to enroll his or her covered dependents at matriculation, coverage for dependents will become effective on the same date the covered student’s benefits become effective, provided enrollment for the dependents occurs on or before the deadline.  No enrollment for dependents is allowed after the deadline unless a qualifying event occurs. The qualifying event can occur any time during the year; however, the student must notify Washington University in writing within thirty-one (31) days of the qualifying event and pay the required additional Student Health Service access fee in order for the dependents to be eligible for coverage. Students will be required to submit a qualifying event Form and supporting documents to provide proof of first-time eligibility to Washington University within thirty-one (31) days of the qualifying event when dependents, other than newborns, join based on a qualifying eent, their coverage becomes effective as of the first of the month following the qualifying Event as long as appropriate payment of the Student Health Services access fee has been provided.  Newborns entering the program as a qualifying event will have coverage effective retroactive to the date of birth. Dependent coverage terminates when the student’s coverage terminates or when the dependent no longer meets the definition of a dependent as described above, if earlier.

Qualifying events for enrollment

The following are allowed qualifying events: marriage, divorce, death, Spouse’s initial arrival to the U.S., birth of a dependent child, legal adoption of a child, legal guardianship, completion of a domestic partner affidavit, or loss of other coverage. The qualifying event can occur any time during the year; however, the student must notify Washington University in writing within 31 days of the qualifying event and pay the required additional Student Health Service access fee in order for the dependents to be eligible for coverage. Students will be required to submit a qualifying event form and supporting documents to provide proof of first-time eligibility to Washington University within 31 days of the qualifying event.

Newborn infants will be covered under the program for routine nursery care for newborn children for up to 96 hours after a caesarean section delivery and for up to 48 hours after any other delivery. Newborn infant means any child birthed by a student, Spouse, or Domestic Partner while that person is covered under this program. Only the student will have the right to continue such coverage for the child beyond the first 48 or 96 hours. If the student does not use this right as stated here, all coverage to that child will terminate at the end of the applicable 48 or 96 hour period after the child’s birth. To continue the coverage, the student must, within 31 days after the child’s birth, complete and return the Qualifying Event Form with payment to Washington University. If properly submitted within this initial 31day period, enrollment for the newborn will be retroactively effective back to the date of birth. A newborn child of a student’s dependent child is not eligible to continue coverage beyond the initial 48 or 96 hour period.

Washington University may require annual verification of eligibility for all dependents enrolled in the program of services.  The annual verification of dependent eligibility will be conducted as part of the process to ensure that health benefits are being provided fairly and consistently to eligible dependents.