Benefits Eligibility - Other Qualified Adults (OQA)
Effective January 1, 2009
For purposes of Other Qualified Adult (OQA) coverage under the U-M’s benefit plans, beginning January 1, 2009, a U-M employee who does not already enroll a spouse in the health or other benefit plans may enroll one adult individual for benefit coverage if all of the following eligibility criteria are met:
- The employee is eligible for U-M benefits; and
- The Other Qualified Adult, at the time of proposed enrollment, shares a primary residence with the employee and has done so for the previous 6 continuous months, other than as an employee or tenant.
The following individuals are not eligible for participation in the OQA program if they are the employee’s or the spouse of the employee’s:
- Parents
- Parents’ other descendents (siblings, nieces, nephews)
- Grandparents and their descendents (aunts, uncles, cousins)
- Renters, boarders, tenants, employees
- Children* or their descendents (children, grandchildren)
* Children of an employee or an employee’s OQA may be eligible for coverage as dependent children, but not as other qualified adults. Eligible children of an Other Qualified Adult may be enrolled. Eligibility for an OQA’s child(ren) is defined by the eligibility criteria for dependent children. See below.
Dependent Children of Other Qualified Adult
In addition to coverage for an OQA, you may also elect coverage for the eligible child(ren) of an OQA. The dependent children of an OQA are eligible for coverage through the end of the month they turn 25 if they:- Live primarily with you but may be temporarily away from home attending school; and
- You and your OQA provide over 50% of your dependent's total support; and
- Are not eligible for coverage through the university as an employee; and
- Are not already covered through the university as a dependent on another university employee’s coverage.
Coverage Eligibility
Your eligible OQA and OQA’s eligible children may be enrolled in the following benefit plans:
- Medical insurance
- Dental coverage
- Vision plan
- Legal plan
- Dependent Life Insurance
- Long-Term Care plan
Click here to download a printable guide: Benefits Resources for Other Qualified Adults
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.
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:
- As a newly hired or newly eligible faculty or staff member.
- After experiencing a qualified mid-year status change.
- During the annual Open Enrollment period.
Canceling Other Qualified Adult Coverage
If your Other Qualified Adult no longer meets the criteria required for OQA coverage, you must notify the HR/Payroll Service Center within 30 days of the loss of eligibility date. For example, OQA eligibility will end if you and your OQA no longer reside together. 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. If you report the loss of eligibility within 60 days, COBRA continuation 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. Your OQA’s children must also be removed when they no longer meet the eligibility criteria for each benefit. If they are removed within the same timeframes discussed above, COBRA continuation information will be sent so that coverage may be continued.
Taxation of OQA Coverage
Important Note: Faculty and staff members who are considering applying for OQA benefits should be aware of the potential tax consequences. For information and an imputed income tax worksheet, see Taxation of OQA Coverage: What You Need to Know.
OQA 2009 Questions and Answers (PDF)
The University of Michigan in its sole discretion may modify, amend, or terminate the benefits provided with respect to any individual receiving benefits, including active employees, retirees, and their dependents. Although the university has elected to provide these benefits this year, no individual has a vested right to any of the benefits provided. Nothing in these materials gives any individual the right to continued benefits beyond the time the university modifies, amends, or terminates the benefit. Anyone seeking or accepting any of the benefits provided will be deemed to have accepted the terms of the benefits programs and the university's right to modify, amend or terminate them.