Dental Plan: Eligibility for Coverage

Who is Eligible

An employee in active employment status working at least 50 percent of the time on a regular appointment is eligible for dental coverage.

Note: There is a 6-month waiting period that must be met before an eligible employee can use the Dental Plan. There is a 1-year waiting period for major restorative and prosthodontic services.

Who is Not Eligible

The following employees are not eligible for dental coverage:

Who is Eligible Under Family Coverage

An eligible employee's dependents are eligible for dental coverage. Eligible dependents include an employee's spouse, domestic partner, unmarried children, and children adopted by the employee or the employee's spouse. Eligibility requirements for a domestic partner are described in the next block.

Spouse

An employee's current or legally separated spouse is eligible. A divorced spouse is not eligible for coverage.

Unmarried Children

Coverage can include an employee's unmarried children who are under age 19 (or under 25 if full-time students) including, but not limited to, stepchildren living at home and children under the employee's legal guardianship living at home.

An employee's unmarried children of any age incapable of self-support due to a mental or physical disability who were disabled before reaching age 19 can be covered subject to medical documentation as required by the insurance carrier.

Note: The Research Foundation is required by law to permit employees subject to a child medical support order to enroll dependent children in a health care plan without regard to open enrollment restrictions.

Exclusions

An employee may not be covered both as an employee and as a dependent of another RF employee. If two members of the same family are employed at the Research Foundation, both can have individual coverage or one can have family coverage.

Eligibility Requirements for a Domestic Partner

An employee may include a domestic partner under family coverage provided that the domestic partner is

Children of Domestic Partners

To be eligible for coverage, children of domestic partners must

Domestic Partner Coverage as Taxable Income

Under Internal Revenue Service (IRS) rules, if a domestic partner is not a "dependent" within the meaning of Section 152 of the Internal Revenue Code, the "fair market value" of the partner's health coverage, less any contribution for dependent coverage by the enrollee, is considered taxable (imputed) income for the employee. The fair market value of RF benefits equals the gross individual premium for the benefits (RF share and employee share) less the employee's contribution for dependent coverage.

Deductions for income tax and FICA contributions on the employee's paycheck and W-2 will be adjusted to reflect this higher income level. Value of Imputed Income for Domestic Partner Coverage is a chart that provides the biweekly increase in taxable income that will appear on the payments and deductions section of the employee's paycheck.

Note: The value of the imputed income is not included for retirement contributions and other benefits will not be affected.

Eligibility During Inactive Employment Status

Unpaid Leave of Absence

An employee on an approved leave of absence without pay may retain dental coverage if he or she pays the total premium to the RF during the leave period. Dental coverage may only be continued in conjunction with continuation of vision care coverage.

Refer to LOA - Continuation of Group Coverage While on LOA Other Than Family and Medical Leave for information, an application for continuation of coverage under leaves of absence, and the premium amounts for coverage.

Leave of Absence Under the Family and Medical Leave Act (FMLA)

An employee on leave under the Family and Medical Leave Act (FMLA) is eligible for dental coverage continuation.

Disability

A disabled employee receiving a benefit from New York State Disability insurance or Workers' Compensation for a total disability is eligible for dental coverage continuation.

Change History

 

 

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