Who Is Eligible for the UVA Health Plan?

Eligibility


Who is Eligible?

The following information is the general eligibility for the UVA Health Plan.

  • Employees

    In general, to be eligible for a UVA Health Plan, you must be employed by UVA full- or part-time, and regularly scheduled to work at least 20 hours per week. To be eligible for the UVA Health Plan, your job must be one of the following types: 

    • Faculty
    • Classified Staff
    • Medical Center Team Member
    • Postdoctoral Research Associate
    • Senior Professional Research Staff
    • University Staff
    • Grant-funded Postdoctoral Fellow (Value or Choice Health only)
    • Housestaff (Value or Choice Health only)
    • Retiree
    • Temporary and Wage Employee (if eligible under ACA). 

    J-1 visa holders are only eligible for the Choice Health option starting in 2018. Federal government regulations prohibit J-1 visa holders from enrolling in the Basic or Value Health options. 

  • Spouses

    For the UVA Health Plan: Must be legally recognized as spouses in the Commonwealth of Virginia and have no access to Affordable Healthcare Coverage of minimum value (as defined by the Affordable Care Act) through their non-UVA employers. 

    For UVA Dental and Davis Vision: Must be legally recognized as spouses in the Commonwealth of Virginia.

  • Children

    Must be your biological, step, adopted, or foster child, or any child declared a dependent on your federal tax return for whom you are the legal guardian with permanent custody. Children are eligible through December 31 of the year they turn age 26. Starting January 1, 2019, children are eligible to the end of the birth month in which they turn 26 rather than the birth year.

  • Adult Children with Disabilities

    If children are incapable of self-support due to mental or physical disability, they can remain on your health option beyond age 26 as long as the following requirements are met:

    • Required documentation is approved in advance by the Aetna Claims Administrator before the dependent’s 26th birthday.
    • They are unmarried.
    • They live with you 100% of the time.
    • They are declared a dependent on your federal tax return.

Required Documentation for Eligible Dependents

Dependent's relationship to you:

  • Spouse

    Eligibility Definition

    • Marriage must be legally recognized in Commonwealth of Virginia
    • Ex-spouses are not eligible, even with court order

    Required Documentation

    • Copy of state-issued marriage certificate received after the date of the ceremony with recorded file date, and 
    • Copy of the first and second pages of the employee’s most recent federal tax return that shows the dependent listed as “Spouse”. Page 2 must include signatures or an e-file confirmation number. “Mark out” all financial information and the first five digits of all Social Security numbers.
  • Biological child

    Eligibility Definition

    • A child may be covered to the end of the month in which he or she turns age 26.

    Required Documentation

    • Copy of birth certificate showing employee as parent
  • Adopted child

    Eligibility Definition

    • A child may be covered to the end of the month in which he or she turns age 26.

    Required Documentation

    • Copy of birth certificate or court approved adoption order showing employee’s name. If this is a legal pre-adoptive agreement, it must be reviewed and approved by the UVA HR.
  • Stepchild (spouse's biological child)

    Eligibility Definition

    • A stepchild may be covered to the end of the month in which he or she turns age 26.

    Required Documentation

    • Copy of birth certificate (or adoption agreement) showing the  employee’s spouse as parent, and
    • Copy of state-issued marriage certificate received after the date of the ceremony with recorded file date showing the employee and dependent parent’s name, and one form of proof of joint ownership, and 
    • Copy of the first and second pages of the employee’s most recent federal tax return that shows the dependent’s parent listed as “Spouse”. Page 2 must include signatures or an e-file confirmation number. “Mark out” all financial information and the first five digits of all Social Security numbers.
  • Foster child

    Eligibility Definition

    • A foster child may be covered to the end of the month in which he or she turns age 26.

    Required Documentation

    • Copy of birth certificate, and
    • Copy of the Final Court Order granting permanent custody with name of employee as responsible party, name of minor children, and presiding judge’s signature, support order number, and seal.
  • Children under your permanent legal guardianship or custody

    Eligibility Definition

    A child for which a court has ordered the employee (and/or the employee’s legal spouse) to assume permanent custody may be covered to the end of the month in which he or she turns age 26 if:

    • They are unmarried,
    • Reside full-time with the employee in a regular parent-child relationships
    • Is declared as a dependent on the employee’s federal income tax return, and
    • Custody was awarded prior to the child’s 18th birthday. 

    Required Documentation

    • Copy of birth certificate, and
    • Copy of the Final Court Order granting permanent custody with name of employee or spouse as responsible party, name of minor children, and presiding judge’s signature, support order number, and seal
  • Children under your permanent legal guardianship or custody - exception

    Eligibility Definition

    If the employee (or the employee’s spouse) shares permanent custody of an “other child” with their minor child who is the parent of the “other child – exception”, then that “other child” may also be covered if the other child, the minor child (who is the parent) and the employee’s spouse (if applicable):

    • All live in the same household as the employee, 
    • Both children are unmarried,
    • Both children are declared as dependents on the employee’s federal tax return, and
    • A court has ordered the employee or the employee’s spouse to assume joint permanent custody.

    Required Documentation

    • Copy of the other child’s birth certificate showing the name of the minor child as the parent of the other child, and
    • Copy of the birth certificate (or adoptive agreement) for the minor child showing the name of the employee, and
    • Copy of the Final Court Order granting custody with names of employee or spouse and their minor child as the responsible parties, name of “other child”, and presiding judge’s signature, support order number, and seal.
  • Incapacitated Adult Child

    Eligibility Definition:

    The employee’s adult children who are incapacitated due to a physical or mental health condition may be covered beyond the end of the month in which they turn age 26 if:

    • They are unmarried,
    • Reside full-time with the employee (or the other natural/adoptive parent),
    • Is declared as a dependent on the employee’s federal income tax return,
    • They are deemed incapacitated prior to the end of the month in which they reach age 26, and

    They have maintained continuous coverage under an employer-sponsored plan of the employee (or the other natural/adoptive parent).

    Required Documentation

    • Copy of birth certificate or legal adoptive agreement showing employee’s name, and
    • Other medical certification and eligibility documentation as needed.
    • In the case of a new employee, copy of the HIPAA Certificate showing prior employer-sponsored coverage.

Contact Aetna Member Services at 800.987.9072 and the UVA Health Plan Ombudsman for assistance.

 

Qualified Life Events

You can make changes to benefit elections during the plan year if you have a qualified life event. Only increases or decreases in enrollment that are consistent with the qualified life event can be made. Switching between plan options cannot be done during the plan year. They can only be requested during Annual Enrollment. Starting January 1, 2019, qualified life events and new hire enrollments will need to be completed within 30 days of the event or hire date.

Required documents for qualified life events