Other Qualified Adult

If you do not already cover a spouse in your U-M benefits plans you may enroll one Other Qualified Adult (OQA) for benefit coverage if all of the following eligibility criteria are met:

  • You are eligible for U-M benefits; 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
  • Parents' other descendants (siblings, nieces, nephews)
  • Grandparents and their descendants (aunts, uncles, cousins)
  • Renters, boarders, tenants, employees
  • Children or their descendants (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:

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.

COBRA

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 OQA's and their children under the same circumstances as for an employee's spouse and children. OQA's 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.