Who is Eligible for Benefits?

Employees:  Group health insurance is available to all permanent, full-time employees and to persons elected or appointed to elected office, unless otherwise mandated by the Patient Protection and Affordable Care Act (PPACA),

Dependents:  Your qualified dependents are eligible for coverage if you elect to enroll in the plans.  Generally, your eligible dependents include:

  • Your legal spouse, according to Federal Guidelines
  • Medical, Vision & Child Life Ins: Your children up to the age of 26*
  • Dental: Your children up to the age of 19*, or up to age of 25 if full time student

*Children determined to be disabled prior age 19 may also qualify for coverage beyond the limits listed above (see qualifying child section below).

According to IRS rules, you must notify Clermont County of any change in your dependent’s eligibility status within 30 days of the change.  Failure to report the change within the 30 day period can result in the loss of your dependent’s coverage and COBRA Rights.
Additionally, an employee could be subject to imputed income if the dependent child does not meet the Qualifying Child definitions listed below:

A Qualifying Child is one who:

  • Is related to the taxpayer – natural child, adopted or foster child, step-child, legal guardianship, and….
  • MEDICAL/VISION/LIFE INS.: Is under age 26
  • DENTAL: Is under age 25*,  and…
    • Does not provide over half of his/her own support, and
    • Has the same principal residence as the taxpayer for more than half the year.

*Dependents deemed totally and permanently disabled may qualify beyond  ages listed.  Check with the Benefits Office.

Documentation:   If you add a new dependent (someone not currently covered), you must provide documentation showing he or she is an eligible dependent. Examples of required documentation:

  • Spouse:  Official marriage certificate or license.
  • Child:  Birth certificate or legal documentation (adoption, guardianship, support order, etc.)
  • Disabled child (disabled prior to becoming ineligible for coverage due to age):  Certificate of disability issued by Social Security.
  • 19-25yrs (child): full-time Student verification when adding to dental.

Dependent Child Coverage ends the last day of the month**:

  • Medical,Vision, Child Life:  last day of the month of the child’s 26th birthday.
  • Dental:
    • Last day of the month of 19th birthday, or 25th birthday if a full-time student;
    • No longer meets the IRS definition of a “Qualifying Child” (see definition above)

*Full-time student documentation must include:  Name of accredited school; list the semester/quarter; show that the child is enrolled as a full-time student (12 or more credit hours).

**IMPORTANT: Employees must notify Clermont County Benefits Office when a covered dependent is no longer eligible for coverage.