19 Del. Admin. Code § 2001-2.0 - Dependents Eligible to Participate
2.1 Dependents must meet one of the following definitions to be eligible for enrollment in the State Plan:
2.1.1 A regular officer's or employee's or eligible pensioner's:
2.1.1.1 Legal spouse or civil union partner (Delaware law does not recognize common law marriage). Ex-spouses, ex-civil union partners, and ex-step-children may not be enrolled in the State Plan even if a divorce decree, dissolution decree, settlement agreement or other document requires an employee or pensioner to provide coverage for an ex-spouse, ex-civil union partner, or ex-step-children;
2.1.1.2 IMPORTANT NOTE: Spousal Coordination of Benefits Policy has been in effect since January 1, 1993 and revised January 1, 2023. The policy applies to a spouse who is eligible for health coverage through their own employer or former employer (when spouse is retired). Spouses who work full-time or who are retired and are eligible for health coverage through their current or former employer, but do not enroll under that employer's health plan, may have a reduction in benefits under the State Plan. A new Spousal Coordination of Benefits form must be filled out upon the spouse's initial enrollment, each year during open enrollment, upon the employee's enrollment in a State Plan administered by the Pension Office as a result of retirement or employment termination due to LTD, or anytime throughout the year the spouse's employment or health insurance status changes. Information on the Spousal Coordination of Benefits Policy, Chart, online form and a Summary Plan Description (SPD) for each health care plan is available on the Statewide Benefit Office's website at de.gov/statewidebenefits.
2.1.1.3 A child or children under age 26 born to or legally adopted or lawfully placed for adoption by a regular officer's, or employee or eligible pensioner or a regular officer or employee's or pensioner's legal spouse;
2.1.1.4 A child or children who do not meet the requirements of subsection 2.1.1.3 of this regulation, who is unmarried, under age 19 (age 24 if a full-time student), residing with a regular officer or employee or eligible pensioner in a regular parent child relationship, and who is dependent upon the regular officer or employee or eligible pensioner for at least 50% support, and who would be considered the regular officer's or employee's or pensioner's "dependent" under Section 105(b) of the Internal Revenue Code. A statement of support form must be filled out by the regular officer or employee or eligible pensioner and forwarded to the employee's Benefit Representative or Human Resources Office with the request for coverage together with a copy of the legal guardianship, permanent guardianship or custody order for the dependent child. If the guardianship or custody order has ended due to the child reaching legal adult age, a statement of support will be required. If a natural parent resides in the same household as the insured regular officer or employee or eligible pensioner, it will be deemed that a regular parent-child relationship does not exist unless the regular officer or employee or eligible pensioner has legal guardianship documents or has legally adopted the dependent child.
2.1.1.5 An unmarried dependent child or children who meet the criteria of subsection 2.1.1.3 of this regulation, but who is age 26 or older and incapable of self-support because of a mental or physical disability which existed before the child reached age 26. The child or children must have been covered under employee's contract immediately preceding age 26.
2.1.1.6 An unmarried dependent child or children who meet the criteria of subsection 2.1.1.4 of this regulation, but who is age 19 (age 24 if full-time student) or older and incapable of self-support because of a mental or physical disability which existed before the child reached age 19 (age 24 if full-time student). The child or children must have been covered under employee's contract immediately preceding age 19 (age 24 if full-time student).
2.1.1.7 IMPORTANT NOTE: A Dependent Coordination of Benefits form must be filled out for each enrolled dependent regardless of age, upon enrollment in other health coverage, any time other health coverage changes, or upon request by the Statewide Benefits Office or the State Plan administrator.
2.2 An eligible dependent child or children covered under the health insurance plans of both parents (one of whom must be employed by a group not participating in the State Plan) will be primary to the parent's plan whose birthday is the first to occur during the calendar year or in response to applicable Court Order. In the event the parents' birth dates are the same, the dependent child will be primary to the parent with the plan that has covered that parent longest. In the event birth dates and length of service are the same, the dependent child will be primary to the mutual choice of the parents.
2.3 An eligible dependent child or children whose parents are divorced or not living together and not married will be primary to the plan of the parent with custody or primary to the plan of the spouse of the parent with custody unless a Court or Administrative Order defines one parent as responsible for the child's or children's health care expenses or health care coverage and if so, that parent's plan will be primary. If a Court or Administrative Order states that both parents are responsible for the child's or children's health care expenses or health care coverage or that the parents have joint custody without specifying that one parent has responsibility for the health care expenses or health care coverage of the dependent child or children the provisions in subsection 2.2 of this regulation shall apply. If there is no Court or Administrative Order allocating custody or responsibility for the child's or children's health care expenses or health care coverage the provisions of subsection 2.2 of this regulation shall apply. Also see subsection 4.9 of this regulation.
2.4 Employing agencies and the Office of Pensions shall maintain files that include such documents as SEBC determines appropriate to administer the State Plan; files shall be subject to audit by the SEBC.
2.5 In accordance with 29 Del.C. §
5202(h) any spouse receiving a survivor's pension benefit from the State Employee Pension Plan, the State Police Pension Plans or the Judiciary Pension Plan may not include a new spouse in the State's pension group health insurance plan effective June 1, 2012.
2.6 Enrollment of a dependent as defined in subsection 2.1 of this regulation is contingent upon enrollment of a regular officer, employee, or eligible pensioner.
Notes
12 DE Reg. 986 (01/01/09)
15 DE Reg. 225 (08/01/11)
15 DE Reg. 1071 (01/01/12)
16 DE Reg. 1003 (03/01/13)
17 DE Reg.
18 DE Reg.
24 DE Reg.
27 DE Reg.
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.