Only certain dependents qualify for coverage under the County health plans and dependent enrollment changes may only be made if reported within 30 days of the qualifying event. If you do not enroll a new dependent within the 30 days you will have to wait until a future Open Enrollment to request coverage.
Common Qualifying Events
- Adoption/Legal Custody
- Legal Divorce, legal separation
- Commencement or termination of spouse's employment which causes a loss or gain of other health coverage
- Entering the U.S. with proper papers
- Domestic Partner
Once you have enrolled a dependent, the County of Orange Benefits Center will request documentation that your dependent meets the eligibility requirements of the plan (i.e., marriage certificate, birth certificate, court custody documentation, divorce decree). You will be required to complete a Dependent Verification Form and return it along with the required documentation. You will have 60 days from the date of the qualifying event to complete this requirement. If you do not return the required form and documentation by the due date, coverage for the dependent(s) will be terminated and you must wait until the next Open Enrollment to enroll them.
Who Can I Enroll?
Eligibility Definitions and Required Documentation
Generally speaking, you may enroll the following dependent on your health plan:
- Spouse or domestic partner (income may be imputed for domestic partners).
- Children under age 26, including step children, foster children, children placed for adoption, legally adopted children, and children of domestic partners. (Income may be imputed for children of domestic partners if you cannot claim them as your dependent.)
Dependent children age 19 through 25 are not eligible if they are eligible for coverage through any other employer health plan except for the group health plan of the other parent, i.e., if your dependent child is eligible for coverage through their own employer, or the employer of their spouse, they are not eligible for coverage under the County of Orange plan.
The term "children" shall not include any legally married spouse, domestic partner or children of your dependent child, i.e., you may not enroll the children or spouse of your dependent child.
Incapacitated children age 26 and over who are dependent upon the participant for support and were incapacitated prior to their 26th birthday. The child did not have to be covered by the County of Orange at the point they became incapacitated if the event was prior to their 26th birthday.
Parents or other adult relatives are not considered eligible dependents for County health plans and cannot be added for any reason.
Reporting Future Dependent Changes
You are required to notify the Benefits Center within 30 days of when a dependent no longer meets the plan eligibility requirements. For example: If you and your spouse divorce, the ex-spouse is no longer eligible and the divorce must be reported within 30 days; or if a dependent over 19 obtains health coverage through his/her employment, he/she is no longer eligible for the County's plan. When notified within the proper timeframe, the dependent will be provided with the opportunity to continue their health coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA) for up to 36 months.
If the Benefits Center is not notified within the proper timeframe, the ineligible dependent may lose their COBRA rights and may not have the opportunity to continue their health coverage. In addition, you may be responsible for repayment of the County's portion of rates paid for the ineligible dependent during the period of ineligibility. You may be responsible for health expenses incurred by an ineligible dependent. Premiums paid for the ineligible dependent will not be refunded.