Oklahoma Administrative Code › Title 260 - Office of Management and Enterprise Services › Chapter 50 - Employees Group Insurance Division - Health, Dental, Vision and Life Plans › Subchapter 3 - Administration of Plans › Section 260:50-3-17 - Dependents

Current through Vol. 41, No. 20, July 1, 2024
Eligible dependents may be enrolled by new employees with
				  their coverage effective concurrently with the employee's coverage if the
				  member has signed the insurance change form requesting such coverage within the
				  member's initial thirty [30] day enrollment period. Dependent coverage not
				  elected at that time shall not become available until the next enrollment
				  period. Dependents are not eligible for any coverage in which the member is not
				  enrolled. Exceptions may apply for dependents electing COBRA or Survivor
				  coverage. When one eligible dependent is covered, all eligible dependents must
				  be covered for all elected coverage. The spouse or dependent may elect not to
				  be covered when the spouse or dependent is covered by other corresponding and
				  verifiable health, group dental or vision coverage. The member can elect not to
				  cover dependents who do not reside with the member, are married, are not
				  financially dependent on the member for support, have other coverage or are
				  eligible for Indian or military health benefits. The spouse may elect not to be
				  covered provided a statement signed by the employee and the spouse is submitted
				  to the Insurance/Benefits Coordinator. Dependent's benefits shall only be
				  covered under one primary insured except in the case of dependent life.
				  Excepted Benefits do not qualify as other coverage for purposes of this rule.
(1) Newborns may be added to coverage
				with the completion of an insurance change form and remittance of any
				appropriate premium for the month of birth to the Insurance/Benefit Coordinator
				within thirty [30] days after the date of birth of the newborn.
(2) When one or more eligible dependents are
				currently covered, the newborn must be added to the same coverage.
(3) Where a newborn is added to coverage, all
				other eligible dependents must be enrolled in coverage if they are not
				currently enrolled. A member can waive health, dental, or vision coverage for
				their spouse.
(4) Eligible
				dependents who lose other health, group dental or vision insurance coverage may
				be added to the equivalent health, dental or vision coverage offered through
				EGID within thirty [30] days after the loss of the other insurance coverage if
				those dependents have been continuously covered by the other health, dental or
				vision insurance, or have been eligible for treatment at military or Indian
				health facilities. Notice and proof of the loss of other coverage and
				termination date of other coverage must be submitted within thirty [30] days
				after the loss of the other coverage. At the insured's option, in order to
				avoid a break in coverage this Plan shall become effective on the first [1 
				st ] day of the month during which the
				insured actually lost previous coverage, provided the insured pays the full
				premium for that month. Otherwise, coverage shall become effective under this
				Plan on the first [1 
				st ] day of the month following notice
				of the loss of other coverage. Excepted Benefits do not qualify as other health
				coverage for purposes of this rule.
(5) Newly acquired dependents may be added if
				the election is made within thirty [30] days after the qualifying event, or
				other federally required mandate, or during the annual enrollment period as
				established by EGID. Documentation proving the qualifying event may be
				required. The effective date of coverage will be the first [1 
				st ] day of the month following
				notification to EGID of the qualified event except for newborn or adopted
				dependent children.
(6) Provided
				all other eligibility requirements are satisfied, adopted eligible dependent
				children, eligible children for which guardianship has been newly granted to
				the insured or the insured's spouse, or eligible children of which the insured
				has been newly granted physical custody pending adoption, guardianship, or
				other legal custody, may be covered from the first [1 
				st ] day they are placed in the
				insured's physical custody, only upon payment of the full monthly premium for
				that individual, not prorated, and only after written notice has been given to
				EGID within thirty [30] days after obtaining physical custody. Copies of all
				documents relating to the matter are also required.
(7) At the insured's option, coverage for
				eligible dependent children newly placed in the insured's physical custody may
				become effective on the first [1 
				st ] day of the second month following
				placement, if written notice is provided within thirty [30] days after the date
				of placement, or at the next option period as established by EGID.
(8) In the absence of a court order
				indicating adoption, guardianship, legal separation or divorce, an insured may
				apply for coverage on other unmarried children living with the insured
				provided:
(1) the insured submits a copy of
				his most recent federal income tax return showing the child was listed as the
				insured's dependent for income tax deduction purposes; and
(2) if the last federal income tax form
				requested above does not list the child, the insured shall be required to
				provide an Application for Coverage for Other Dependent Children form
				prescribed by the Plan; and
(3)
				coverage, if approved, shall begin on the first [1 
				st ] day of the month following
				approval, and will never apply retroactively except in the case of a newborn
				which shall be added the first [1 
				st ] of the month of birth; and
(4) all other applicable
				eligibility requirements must be satisfied; and
(5) all necessary premiums have been paid.
				EGID shall have the right to verify the dependent's status, to request copies
				of the insured's federal income tax returns from time to time, and to
				discontinue coverage for such dependents if they are found to be ineligible for
				any reason.