Students with Dependents
Dependents of an enrolled student can enroll within the first 30 days of each coverage period during the plan year. Dependents include a spouse, same-sex domestic partner or opposite-sex domestic partner if one or both partners are age 62 or over and eligible for Social Security benefits based on age. Natural born or adopted children up to age 26, or foster children up to age 18 of the student or adult dependent are eligible for enrollment. An unmarried adult child over the age of 26 may be eligible if the child is chiefly dependent on the student, spouse or domestic partner for support and is incapable of sustaining employment due to a physical or mental condition. See benefit booklet for a complete description of eligible dependents.
Newborns are provided coverage under the parents' benefits for the first 31 days, up to a maximum of $25,000. Students must contact Wells Fargo to enroll a newborn. For coverage after day 31, newborns must be enrolled as a dependent on the plan.
Dependents are not seen at SH. They will need to seek care in the community. Please see our list of providers in the community (coming soon).
Non-registered students and dependents of students must enroll within 31 days of the start of the coverage period.
Enrolled students may purchase coverage for their dependents by contacting Wells Fargo Insurance Services at 800-853-5899 or downloading the Dependent Enrollment Form for either Graduate Students or Undergraduate Students.
The following documentation is required for dependent enrollments:
- For spouse, a marriage certificate
- For domestic partner, a Declaration of Domestic Partnership issued by the State of California, or of same-sex legal union other than marriage formed in another jurisdiction, or a completed Declaration of Domestic Partnership form issued by the University
- For natural child, a birth certificate showing the student, spouse or domestic partner is the parent of the child
- For stepchild, a birth certificate and a marriage certificate showing that one of the parents listed on the birth certificate is married to the student
- For adopted or foster child, documentation from the placement agency showing that the student, spouse or domestic partner has the legal right to control the child's health care
Eligibility Dates
|
Term
|
Effective Date
|
Termination Date
|
Enrollment Deadline
|
|
Fall
|
9/23/2012
|
1/6/2013
|
10/23/2012
|
|
Winter
|
1/7/2013
|
3/31/31
|
2/7/2013
|
|
Spring
|
4/1/2013
|
9/21/2013
|
5/1/2013
|
|
Summer
|
6/25/2011
|
9/21/2013
|
7/25/2013
|
Dependent Rates
|
|
Undergraduate
|
Graduate
|
|
Dependent
|
$1,325.14/qtr.
$3,975.42/yr.
|
$1,331.27/qtr.
$3,993.81/yr.
|
|
Child(ren)
|
$1,150.02/qtr.
$3,450.06/yr.
|
$1,156.62/qtr.
$3,469.86/yr.
|
|
Partner & Children (Family)
|
$2,469.51/qtr.
$7,408.53/yr.
|
$2,480.37/qtr.
$7,441.11/yr.
|
Summary of Benefits for Dependents:
Medical
Pharmacy