Wisconsin State Employees FAQ About Dependent Eligibility

P.O. Box 2078
Madison, Wisconsin
53701-2078
www.pplusic.com

(608) 282-8900
(800) 545-5015

Dependent Eligibility FAQs

Who is eligible as a dependent?
If you select family coverage, your eligible dependents are your spouse and unmarried children. Unmarried children are eligible for coverage to the end of the month in which they turn age 27.

The State’s new definition of a dependent does not match the IRS definition of a dependent. Physicians Plus cannot provide advice on the tax implications of covering dependents; we encourage you to seek advice from a tax professional on this issue. Eligible dependents are:

Your natural children
Adopted children and pre-adoption placements. Coverage will be effective on the date that a court makes a final order granting adoption by the subscriber or on the date the child is placed for adoption with the subscriber, whichever occurs first. These dates are defined by Wisconsin Statute 632.896. If the adoption of a child is not finalized, the insurer may terminate coverage of the child when the adoptive placement ends.
Legal wards that became wards of the subscriber before age 27. Coverage will be effective on the date that a court awards permanent guardianship to the subscriber.
Stepchildren
Grandchildren born to insured dependent children may be covered until the end of the month in which your insured dependent (your grandchild's parent) turns age 18. Your child's eligibility as a dependent is unaffected by the birth of the grandchild. The grandchild may be eligible for coverage as a continuant.

I have a change in status of a subscriber/dependent. What am I supposed to do?
Report changes to your benefits/payroll/personnel office within 30 days of the change. Failure to report changes on time may result in loss of benefits or delay payment of claims.

How do I know if my dependent is eligible?
Physicians Plus reviews dependent eligibility status (ages 19-27) each year. A form is sent to the subscriber each December. The subscriber must complete the form, sign and date it. If the dependent is no longer eligible for coverage, the subscriber should complete the Employer Enrollment/Change Form, available through your benefits/payroll/personnel office.