What happens when I want to enroll an eligible dependent in the PEBT Benefits Program?

You may enroll your eligible dependents in the PEBT Benefits Program.

If you are enrolling an eligible dependent, you must enter the dependent(s)’ names on:

The following individuals are considered eligible dependents:

Spouse:
The person legally married to the employee or a person of the opposite or same sex who has been residing with the employee in a common-law relationship for the period of time specified in the definition of spouse in the My Benefits section of this website and who is publicly represented as the employee’s spouse.

Employees can only enroll one spouse in the PEBT benefits program at a time:

  • A legal spouse
  • An estranged spouse (separated)
  • An ex-spouse (divorced)
  • A common-law spouse (opposite or same sex)

Coverage may not be continued for an ex-spouse without a court order that states the member must continue coverage for the ex-spouse under the “employer-sponsored plan”.

You must sign the Common Law Spouse Declaration Form to enroll a common-law spouse.

Dependent Child(ren):

For extended health and dental coverage, see the definition of dependent children in this website’s Summary of Benefits of the My Benefits section.

For child optional life: Up to age 21, or 25 if in full-time attendance at school, to any age for disabled children. A child is effective from birth. If the child is institutionalized, the benefit will not be effective until the child ceases to be confined.

DEPENDENT CHILDREN MAY INCLUDE:

Child with a disability:

A mentally or physically dependent child with a disability may be covered to any age provided the child is incapable of self-sustaining employment and is wholly dependent upon you or your spouse for support and maintenance.

If you are enrolling a child with a disability as a dependent the following steps must be taken:

  • You should indicate any applicable information regarding the child’s disability status on the PEBT Benefits Enrolment Form.
  • Benefit provider(s) may require additional information later to verify the child’s status. If required, the benefit provider(s) will request the additional information directly from you.
  • You should contact your School District Benefits Administrator if your dependent child becomes disabled later.

Step child / Adopted child:
If you are enrolling a step/adopted child as a dependent following your initial enrolment into the PEBT Benefits Program, the following steps must be taken:

  • You must complete the PEBT Benefits Change Form to add a legally adopted child as a dependent and provide the form to the School District Benefits Administrator.
  • The form must include the date of adoption.
  • Stepchildren must be living with and/or legally adopted by you to be considered eligible dependents.
  • Coverage will be effective on the effective date of the change.

Legal wards:
If you are enrolling a legal ward as a dependent child, the following steps must be taken:

  • You must complete the PEBT Benefits Change Form to add a legal ward as a dependent child and provide that form to the School District Benefits Administrator.
  • You must provide a copy of the court document. Please note that a notarized statement is not sufficient.
  • Coverage will be effective on the effective date of the change.

Note: Grandchildren can be eligible dependents only if legally adopted by, or legal wards of, the employee.

DEPENDENTS THAT ARE ENROLLED AS LATE APPLICANTS:

If you apply for coverage for your dependents later than four months following their initial eligibility date, the dependent(s) will be considered a late applicant(s).

For extended health and dependent life (where applicable): If your dependent(s) is/are considered a late applicant, they must provide satisfactory medical evidence of insurability to the provider prior to becoming eligible for coverage. To become eligible for coverage, the following steps must be taken:

  • Complete the Evidence of Insurability Form and submit it to the provider.
  • The provider will send the school district a letter stating whether your dependent(s) has been approved or denied coverage. Once the letter has been received, the administrator can enroll the dependent using the administration system with the effective date stated in the letter.
  • Coverage commences when formal written approval is received from the provider(s). Retroactive premiums to the effective date of coverage may be required.

For dental: If your dependent(s) is/are considered a late applicant, the effective date of coverage will be based on whether your district requires a dental declaration submitted for approval or if there is a dollar amount restriction for the first year of coverage (i.e. $100/$200/$250 maximum in the first year). Your District Benefits Administrator will advise you which dental late applicant rules apply to your plan. Based on these options, the following steps must be taken for the dependent(s) to become eligible for coverage.

  • For school districts that require a dental declaration to be submitted, the district administrator will send the declaration as well as a copy of the PEBT Enrolment Form to the provider. The benefit provider will send the school district a letter stating whether your dependent(s) have been approved or denied coverage.
  • If approved, the effective date of coverage will be the 1st of the month following approval by the provider.
  • For school districts that have a dollar amount late applicant restriction for the first year of coverage, the district administrator will send a copy of the PEBT Enrolment Form to the provider.
  • The effective date of coverage will be the date indicated by the benefits administrator on the enrolment form.