Page 3 - SBCEO Benefit Guide 19-20_FINAL

Enrollment Information 3

Who Can Enroll
SBCEO provides benefits through SISC. If you are a regular full-time or part time employee working at least 20 hours a week,
you and your eligible dependents may participate in the SBCEO benefits program. Your eligible dependents include:
 Legally married spouse
 Opposite-sex domestic partner with signed SISC affidavit or registered domestic partner for same-sex or opposite sex,
where at least one is 62 or older
 Children under the age of 26 regardless of student or marital status
 Physically or mentally handicapped children over the age of 26
 Foster children, stepchildren and your registered domestic partner’s children who live with you and meet the above
criteria
Proof of Dependent Status
The following documentation is required to enroll/change medical and/or dental enrollment for your eligible dependents:

Eligible Dependents Required Documentation

Legally married spouse A copy of your marriage certificate and a copy of the first page of your prior
year’s federal tax return (1040); financial information may be blacked out
Domestic Partner Certificate of Registered Domestic Partnership issued by State of California and
SISC Affidavit of Domestic Partnership

Children up to age 26, regardless of A birth certificate, adoption or legal guardianship papers
student or marital status

Disabled dependent over the age of 26 All of the following:
1) Legal birth certificate
2) Most recent federal tax return that shows child is claimed as an IRS
dependent
3) Proof of 6 months prior creditable coverage
4) Completed Anthem Disabled Dependent Certification form.

Mandatory Health Plan Enrollment

All permanent or probationary employees who are benefit eligible must participate in an SBCEO group
medical plan unless the employee is covered under an alternative medical plan (certification required).
For more details, refer to memo: IS- 2440 Eligibility for Benefits located on the SBCEO Intranet under the
Employee Benefits tab at http://intranet.sbceo.org.

When You Can Enroll
As an eligible employee, you may enroll at the following times:
 As a new hire, you may participate in SBCEO’s benefits program as follows:
 If you worked at least 50% of the number of work days in your hired month, you are eligible for benefits First of
the month following date of hire.
 If you worked less than 50% of the number of work days in your hired month, you are eligible for benefits First
of the second month following date of hire.
 Each year, during open enrollment
 Within 31 days of a qualifying event as defined by the IRS (see Changes To Enrollment on the next page)