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Benefit Options
Enrollment Information
Additional Resources
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Who Is an Eligible Dependent?
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It is your responsibility to be certain of your dependents’ eligibility before adding them to your enrollment. Any questions should immediately be addressed to the UPMC Employee Service Center at 1-800-994-2752, option 3. In addition, UPMC may at any time audit eligibility under the plan. If you are selected as part of the audit, you will be required to provide proof of a dependent relationship, such as, marriage certificate for spouse or a birth certificate for a child. |
Eligible dependents include your legally married spouse, certified domestic partner, and qualified dependent child.
Documentation is required when adding to benefits a spouse, domestic
partner*, child who is placed with you for adoption, child for whom
you are the legal guardian, a child that does not meet all the dependent
child criteria listed below, or a child between ages 19 and 25 (if
a full-time student).
You must provide documentation within 30 days of enrolling dependents on your UPMC benefits or they will be removed from coverage.
Legally Married Spouse |
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In accordance with Pennsylvania state law, the individual to whom you are legally married through a governmental or religious ceremony. For common law marriages you must have an approved common law affidavit on file with UPMC to cover a common law spouse under the UPMC Welfare Benefits Plan. |
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Certified Domestic Partner* |
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Your domestic partner* and the partner's dependents, provided they meet the dependent child criteria below. An approved Affidavit of Domestic Partnership must be on file with the UPMC Employee Service Center. |
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Dependent Child |
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Your biological dependent child, stepchild, legally adopted child, child placed with you for adoption, or child for whom you are a court-appointed legal guardian, provided he or she:
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If you get divorced or separated, a special court order may require you as a parent to provide for your child's health coverage. This is called a Qualified Medical Child Support Order. If this is the case and the court order satisfies all of the applicable legal requirements, UPMC will offer coverage to the extent provided by law.
Documentation is not required at this time for biological or step-children who reside with you and meet all the other dependent child criteria listed above.
Dependent coverage continues as long as your own coverage continues. In addition, your dependent child's coverage ends on the last day of the month in which the earliest of the following events occur:
- Attains age 19 (or 25 if covered as a full-time student)
- Full-time student status is not maintained and documented (except as indicated above due to total disability or approved medically necessary leave of absence).
- Dependent child marries.
- Disabled dependent ceases to be disabled and no longer qualifies as an eligible dependent.
Dual Coverages
If you and your spouse or domestic partner are both employed by UPMC, only one of you may cover your children as dependents under any one health or welfare plan. Also, if you are covered under a plan as a staff member, you may not be covered under that same plan as a dependent. The supplemental life insurance coverage for dependents does not cover dependents who are also eligible staff members of UPMC or one of its affiliates.
*UPMC Mercy Eligible Dependents
UPMC Mercy is covered by Ethical and Religious Directives for Catholic Health Care Services. All benefit plans have been designed to comply with these directives. The definition of Eligible Dependents under UPMC's benefit plans for UPMC Mercy employees does not include domestic partners.
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