Eligibility

Employee Eligibility

The benefits for which you are eligible as an employee depend on a range of factors, including:

Refer to your MOU or Salary Ordinance or contact the Employee Benefits Center (EBC) for more information about the benefits for which you may be eligible.

Dependent Eligibility Criteria

You may choose to enroll individuals who meet the definition of an “eligible dependent” in a plan in which you participate. Your eligible dependents generally are defined as your:

  1. Legal Spouse
  2. Domestic Partner, who meets the County of Alameda’s (County) domestic partner criteria and the domestic partner’s children who meet the eligible dependent criteria are eligible for enrollment in a plan in which you participate.
  3. Children, including young adult dependents up to age 26, defined as your biological children, stepchildren, adopted children, children placed for adoption with you, domestic partner children, those for whom you have legal guardianship, and those children listed under the terms of a Qualified Medical Child Support Order (QMCSO)
    1. Note: Marital status, student status and place of residence no longer impact eligibility for young adult dependents age 19 to 26.
  4. Dependents of any age with a mental or physical disability who are incapable of self-sustaining employment because of that disability.

Dependent Supporting Documentation

    1. Spouse:  Original or photocopy of your certified marriage license
      1. Note: You cannot cover an ex-spouse on our plan, even with a court order.
    2. New to the Plan Domestic Partner:  The County’s Domestic Partner Affidavit Form (available upon request from the EBC) or California State Affidavit.
      1. Note: Coverage is offered on an after-tax basis, and the County’s portion of the cost is considered taxable income by the IRS.
    3. Dependent Children up to Age 26:  A copy of the child’s certified birth certificate with you, your spouse and/or your domestic partner registered as parent(s), or court-filed guardianship/adoption papers.
    4. Dependents with Disabilities (age 26 or older): Dependents age 26 or older who are physically or mentally challenged, and incapable of self-care may be eligible for continued coverage if they are currently enrolled, were disabled prior to reaching age 26, and you provide the following:
      1. Documentation noted above under “Dependent Child(ren)” and,
      2. Proof of disability, satisfactory to Plan Provider guidelines.

    Contact the EBC for specific instructions. Note: Disabled dependents age 26 or older, and not currently enrolled in Group Coverage through the County are ineligible and cannot be added to your County coverage.

    If dependent coverage is cancelled due to a dependent’s ineligibility for benefits, continuation of coverage through COBRA is not an option.

    Enrollment/Election Changes

    This section highlights when you may enroll or make changes to your benefits during the year.

    Qualifying Status Change for Making Changes During the Year

    Your opportunity to change your benefits elections outside of the Open Enrollment period must qualify as a qualifying event or change in family status as defined by the Internal Revenue Code, Section 125. (To make changes, please request applicable forms from the EBC.)  To change your benefit elections outside of the Open Enrollment period, you must complete and submit the appropriate documentation within the qualifying event dates below:

    Within 30 Days of these Qualifying Events

    • Marriage/Domestic partnership.
    • Birth or adoption of a child.
    • Return from a leave of absence.
    • Relocation by you or your enrolled dependent outside of the medical plan’s service area.
    • Your dependent’s death.
    • Your dependent child gains eligibility under the plan due to loss of other coverage.
    • Your Young Adult Dependent (YAD) is eligible or becomes eligible for medical coverage through your YAD’s employer, or YAD’s spouse’s employer.
    • A change in your or your dependent’s own employment status that impacts your eligibility for benefits.
    • A judgment, decree, or order resulting from a divorce, legal separation, annulment, or change in legal custody that requires health coverage for your dependent child.
    • Loss of alternate medical or dental coverage.

    Within 60 Days of these COBRA-Qualifying Events

    • Divorce, legal separation, termination of domestic partnership.
    • Loss of your child’s dependent status under the Plan due to age.
    • You or your enrolled dependent becomes eligible for Medicare, Medicaid, or COBRA coverage under this plan.

    It is the employee’s responsibility to contact the EBC when the employee experience a qualifying event within the applicable 30-day or 60-day timeframes.

    • If employees do not notify the EBC within the 30-day timeframe, they will not be able to change their coverage.
    • If employees do not notify the EBC within the 60-day timeframe, COBRA coverage will not be offered. However, it is mandatory that you contact the EBC when you experience a COBRA qualifying event.

      Annual Open Enrollment

      Each year, usually in October, the County conducts its annual benefits “Open Enrollment” for eligible employees to assess their benefits needs and make changes to their elections for the new benefit plan year.

      During annual Open Enrollment, you may complete the enrollment process if you wish to:

      • Change your current benefits elections.
      • Enroll yourself and/or your eligible dependents for the first time or drop coverage for yourself and/or your eligible dependents.
      • If eligible, contribute to the Health Flexible Spending Account (FSA), Dependent Care FSA and/or Adoption Assistance FSA.
      • Purchase additional vacation.

      The Open Enrollment period for 2025 happens in the Fall of 2024.  Benefits elected during this year’s Open Enrollment are effective as follows:

      • January 1: Health FSA, Dependent Care FSA, Adoption Assistance FSA, Vacation Purchase elections; Voluntary Disability, Supplemental Life, Accidental Death and Dismemberment (AD&D), Voluntary Benefits.
      • February 1: Medical, Dental and Vision.

        New Hire Enrollment

        Your initial enrollment window as a new hire is the time during which you may enroll yourself and your eligible family members for County-sponsored benefits.

        You must complete the enrollment process within 30 days of your employment start date. Otherwise, your next opportunity to enroll will be during the Annual Open Enrollment period in the fall.

            COBRA

            If you or a covered dependent lose eligibility for County-sponsored health plan coverage, you may be able to extend your medical, dental and vision coverage through the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA).

            COBRA-qualifying events include, but are not limited to:

            • Divorce, legal separation, or termination of your domestic partnership.
            • Your dependent child’s loss or gain of dependent status under the plan (due to age or full-time student status).
            • You or your enrolled dependent becomes eligible for Medicare, Medicaid, or COBRA coverage under this plan.
            • A change in your dependent’s or your own employment status that impacts your eligibility for benefits.

            COBRA participants have the same benefit coverage as employees, including the ability to enroll in or change health plans during Open Enrollment. Participants pay the full cost of their coverage plus an administrative fee.

            You must notify the EBC within 60 days of the COBRA-qualifying event to be eligible to continue coverage through COBRA.