Spouse and Dependents - COBRA Participants

A spouse is eligible for enrollment in the State's health plan if they are a legal spouse or civil union partner. (Delaware law does not recognize common law marriage). Ex-spouses and ex-civil union partners are not eligible to be enrolled.

Please Note: A spouse's enrollment in the State of Delaware Group Health Insurance Plan does not automatically guarantee primary coverage under the State's health plan.

The Spousal Coordination of Benefits (SCOB) Policy is a State of Delaware policy and applies to all spouses enrolled under the State's health plan. It is the member’s responsibility to review the SCOB Policy and Chart before enrolling a spouse under their health plan.

A spouse’s eligibility for primary coverage under the policy is determined on whether a spouse is offered healthcare benefits by their employer (or former employer) and the percentage amount they would be required to pay for the lowest individual plan available to them. It is not based on plan design, total plan cost or salary negotiations.

If you cover a spouse under your Highmark Delaware or Aetna health plan, you are required to complete an online SCOB Form immediately upon first enrolling your spouse, within 30 days of your spouse’s health care coverage or employment information changing, and every year during the Annual Benefits Open Enrollment.

You, your spouse, or your spouse’s employer may be required to provide additional information.

State of Delaware employees may enroll their eligible dependent children in the State of Delaware Group Health Insurance Plan with no restriction in regard to the dependent’s marital, employment, student, resident or tax status. Ex-stepchildren are not eligible to be enrolled.

The Dependent Coordination of Benefits (DCOB) Policy determines which coverage is primary when dependent children are covered under a State of Delaware health plan and also have other health coverage. The policy only applies to health plans, which includes prescription coverage.

A Dependent Coordination of Benefits form for Highmark Delaware or Aetna must be completed for each enrolled dependent regardless of age, upon:

• Enrollment in other health coverage (Ex: Coverage through another parent, the dependent’s spouse or their own employer),
• Any time other health coverage changes, or
• Upon request by the Statewide Benefits Office, Highmark Delaware or Aetna.

The DCOB Form must be submitted directly to the health plan carrier, Highmark Delaware or Aetna. If your dependent does not have any other health insurance, you do not need to complete the DCOB Form.

Per the Group Health Insurance Plan (GHIP) Eligibility and Enrollment Rules, an eligible dependent cannot be enrolled more than once under the State plan and can be enrolled under either parent.