Dependent Definitions

You are eligible to enroll in the Plan if you are a regular full-time (1.0 FTE) or part-time (.5 FTE) Employee who is scheduled to work at least 20 hours per week.

Your eligible Dependents may also participate in the Plan. An eligible Dependent is considered to be: 

• your legal spouse or common law spouse (if a Declaration of Informal Marriage has been obtained) of the opposite sex,
• your child who is under age 26, including a natural child, stepchild, a legally adopted child, or a child placed for adoption,
• your unmarried grandchild under age 26 whose parent is also covered on the medical plan and the grandchild lives with you and is a dependent for tax purposes,
• an unmarried child under age 18 for whom you are the court appointed legal guardian, and the child lives with you and is a dependent for tax purposes, or 
• your unmarried child, who meets all of the requirements above based on the child’s relationship to you, but is over the maximum age limit and who is or becomes disabled and dependent upon you.

Note: Your Dependents may not enroll in the Plan unless you are also enrolled. If you and your Spouse are both covered under The Methodist Hospital System Medical Plan, you may each be enrolled as an Employee or be covered as a Dependent of the other person, but not both. In addition, if you and your Spouse are both covered under The Methodist Hospital System Medical Plan, only one parent may enroll your child as a Dependent. 

A Dependent also includes a child for whom you are required to provide health care coverage through a Qualified Medical Child Support Order or other court or administrative order, as described in Section 13, Other Important Information.

Changing Your Coverage

• Change of Status

A change of status is defined as:

- change in legal marital status due to marriage, death of a spouse, divorce, annulment or legal separation;

- change in number of Dependents due to birth, adoption, placement for adoption, or death of a Dependent;

- change in employment status of Employee, spouse or Dependent due to termination or start of employment, strike, lockout, beginning or end of unpaid leave of absence, including under the Family and Medical Leave Act (FMLA), or change in work-site that results in eligibility or ineligibility for coverage;

- Change in employment status of Employee, spouse or Dependent resulting in eligibility or ineligibility for coverage;

- change in residence of Employee, spouse or Dependent to a location outside of the Employer's network service area; and

- changes which cause a Dependent to become eligible or ineligible for coverage.