Eligibility & Enrollment

You may select one of the following coverage levels for each benefit:

• Non-Medicare-Eligible Retiree: Coverage for yourself only
• Non-Medicare-Eligible Retiree + 1 Non-Medicare-Eligible Dependent: Coverage for yourself and your non-Medicare-eligible spouse/domestic partner or an eligible child
• Non-Medicare-Eligible Retiree + 1 Medicare-Eligible Dependent: Coverage for yourself and your Medicare-eligible spouse/domestic partner
• Non-Medicare-Eligible Retiree + Family: Coverage for yourself and two or more dependents (spouse/domestic partner and/or children)
• 1 Medicare-Eligible Retiree: Coverage for yourself only
• 1 Medicare-Eligible Retiree + 1 Non-Medicare-Eligible Dependent
• 1 Medicare-Eligible Retiree + 2 Non-Medicare-Eligible Dependents
• 2 Medicare-Eligible Retirees + 1 Non-Medicare-Eligible Dependent

The following are considered eligible dependent children:

• Your or your spouse/domestic partner’s children, natural children, stepchildren, newborns, legally adopted children, and children who the plan has determined are covered under a Qualified Medical Child Support Order as defined by any applicable state law; and
• Children from whom you or your spouse/ domestic partner is a legal guardian or as otherwise required by law. (You are required to give the DeKalb Benefits Team a copy of any legal documents awarding guardianship of any new dependents.)

All enrolled children will continue to be covered through the end of the month in which they turn 26. Coverage may be continued past the age limit based on certain circumstances. Please review the Summary Plan Descriptions for further information.

For purposes of this plan, a domestic partner shall be treated the same as a spouse, and a domestic partner’s child, adopted child, or child for whom a domestic partner has legal guardianship, shall be treated the same as any other child.

Any federal or state law that applies to a Member who is a spouse or child under this plan shall also apply to a domestic partner or a domestic partner’s child who is a Member under this plan. This includes, but is not limited to, COBRA, Family and Medical Leave Act (FMLA), and Coordination of Benefits (COB). A domestic partner’s or a domestic partner’s child’s coverage ends on the date of dissolution of the domestic partnership.

To apply for coverage as domestic partners, both the eligible retiree and the domestic partner must complete and sign the Affidavit of Domestic Partnership in addition to completing the enrollment changes online and must meet all criteria stated in the Affidavit. Signatures must be notarized. The plan reserves the right to make the ultimate decision in determining eligibility of the domestic partner.

You and your domestic partner must submit an accurate and completed Declaration of Partnership Form and meet all the requirements listed on this form. Continued eligibility depends upon the continuing accuracy of this form. Domestic partner eligibility ends on the date a domestic partner no longer meets all the requirements listed on this form.