Eligibility Definition
Associates:
All full-time benefits-eligible associates (working 30 – 40 hours a week or 0.75 – 1.00 FTE) and all part-time benefits-eligible associates (working 20 – 29 hours a week or 0.50 – 0.749 FTE) who have satisfied the waiting period, are eligible to participate in Nemours Children’s Health benefits.
Spouse:
Your legal spouse.
Dependent Children:
Dependent children may be covered up to the age of 26, and beyond the age of 26 if disabled before age 26. A disabled child must be certified as disabled prior to the age of 26 AND must be primarily supported by the associate.
The following children are eligible to be covered under the Nemours Children’s benefits plans, regardless of residence or financial dependency:
- An associate’s biological or adopted child
- An associate’s step-child (defined as the child of your legal spouse)
- An associate’s legal ward
- An associate’s foster child (to age 18 only, letter of placement required)
- A child for whom an associate has a Qualified Medical Child Support Order (QMCSO)
According to the above requirements, the following dependents would NOT be eligible for coverage under Nemours benefits plans:
- Opposite-sex and same-sex domestic partner
- Common law spouse
- Divorced or legally-separated spouse
- Children who live in the associate’s home and are financially dependent but who are not legal wards of the associate (for example, grandchild or child of opposite-sex or same-sex domestic partner)
Dependent Verification
Any dependents added to the Nemours benefit plans—this includes spouses and children — are subject to an eligibility verification process. There is no verification required for dependents covered under Voluntary Life, Accident, Critical Illness, Hospital Indemnity, and Identity Theft. If you elect dependent coverage, you will be asked to provide documentation (e.g., birth or marriage certificate, tax return, etc.) to verify your dependents’ eligibility. Please note, your dependents will not be enrolled for benefits until you have provided the required documentation and their eligibility has been verified. Dependent verification for new hires and those that experience a status change, must be completed within 30 days of their date of hire or status change date. For QLEs, documentation must be provided within 60 days of the date of the qualifying life event.
Spousal Surcharge
If your spouse is eligible for health insurance through his/her/their employer but you elect to cover him/her/them on the Nemours health plan, you will pay an additional $300 per month ($150 semi-monthly) in payroll contributions for this coverage. The surcharge is not applicable if your spouse does not have coverage available through his/her/their employer; your spouse does not work; your spouse works at Nemours; or your spouse is self-employed.
For Example
When Sabrina signed up for her benefits, she opted to cover her spouse, as well. Adding her spouse to Sabrina’s plan increased the total premium cost — not just for Sabrina, but also for Nemours. The premium cost that Sabrina is responsible for is what’s left after Nemours has paid its contribution, plus a spousal surcharge as Sabrina’s spouse is also offered coverage through a different employer. Sabrina must also submit documentation verifying that her spouse is an eligible dependent, in order for her spouse to have coverage on Sabrina’s benefits plan.