If you do not already cover a spouse in your U-M benefits plans you may add one Other Qualified Adult (OQA) to your benefit coverage if all of the following eligibility criteria are met:
- You are eligible for and enrolled in the U-M benefits to which you wish to add your OQA; and
- The OQA, at the time of your requested enrollment, shares a primary residence with you and has done so for the previous 6 continuous months, other than as your employee or tenant.
The following individuals are not eligible for participation in the OQA program if they are your or your spouse's:
- Parents' other descendants (your or your spouse's siblings, nieces, nephews)
- Grandparents and their descendants (your or your spouse's aunts, uncles, cousins)
- Renters, boarders, tenants, employees
- Children or their descendants (your or your spouse's children, grandchildren)
Enrolling Your Other Qualified Adult for Coverage
Generally, there are three times when you can add your OQA to your benefits at the University of Michigan:
- As a new hire or newly eligible faculty or staff member, providing that your OQA has fulfilled six-month shared residency requirement for OQA eligibility for coverage under your U-M benefits.
- Within 30 days of a qualified mid-year status change. This could include the date your OQA newly satisfies the six-month shared residency requirement for OQAs. Please be aware the university reserves the right to require proof of eligibility upon request.
- During the annual open enrollment period, usually in October with changes effective January 1, providing that your OQA has fulfilled the six-month residency requirement for OQA eligibility.
Continuous Shared Residency Requirement
To remain eligible for coverage, you and your OQA must continuously share the same primary residence. If your OQA no longer resides with you, you must notify the SSC Contact Center within 30 days of the date your OQA moved from your residence by calling (734) 615-2000 local or (866) 647-7657 toll free. Coverage for your OQA and your OQA's children will terminate at the end of the month of their move. Failure to provide notification of the loss of eligibility within 30 days may result in additional and unwanted imputed income, in addition to claims and premium costs to you.
Using a Health Care Flexible Spending Account
Under current IRS regulations, expenses of your OQA and/or your OQA's children can be submitted for reimbursement under a Health Care FSA only if they qualify as eligible dependents that you can claim on your federal income tax return.
Please note that OQAs of active employees must enroll in Medicare Parts A and B when they first become eligible (due to disability or age). Medicare becomes primary for OQAs regardless of employment status.
Although federal law does not require the university to provide OQA's with COBRA health care continuation coverage, the university will provide such equivalent coverage to OQAs and their children under the same circumstances as for an employee's spouse and children. OQAs must apply for COBRA within sixty (60) days of the date that eligibility for coverage ends.
You or your OQA must submit a Notice of Qualifying Event form to report the loss of eligibility within 60 days of the qualifying event and COBRA continuation information will be sent to your OQA. Failure to report the loss of eligibility within 60 days will result in forfeiture of your OQA's rights to COBRA continuation.
Re-Enrollment Following a Prior Loss of Eligibility
If you remove your OQA from your coverage due to a separation or break of shared residency, you may not request enrollment of your OQA until a second period of six months of continuous shared residency has been established.