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Eligibility Rules
The eligibility guidelines for the ISEBA Health Insurance Plans are established solely by ISEBA.
Employee Eligibility Rules
To be eligible for coverage you must be a Member.
Member means any person who is a Full-Time Employee of the Planholder. The definition of Full-time employee is determined by the school district in accordance with ISEBA guidelines. Member will also include any such person who retires, provided they have maintained continuous coverage with the Planholder under the Group Plan.
Eligibility guidelines for Retired Members are determined by each school district and are set forth in the benefit booklet-certificate.
Dependent Eligibility
Coverage for eligible dependents is effective on the later of:
- the date the Member is eligible for coverage; or
- the date the Member first acquires a dependent
The following individuals are eligible for dependent coverage provided the Planholder provides coverage for dependents.
Spouse or common-law
Spousal coverage will begin on the employee's effective date for employees who are already married. Coverage will begin on the date of marriage for those who marry after enrolling in the health insurance program.
Same sex marriages are legal in Iowa as of April 27, 2009 based on a State of Iowa Supreme Court ruling. Members must notify ISEBA, if appropriate, within 31 days of the qualifying event.
Recognition of common-law marriage is at ISEBA's discretion as it pertains to eligibility for spousal coverage. The school district must request a form from ISEBA, which the employee must submit for consideration. ISEBA will consider the following:
- Does the couple have a joint/mortgage or rental agreement/lease?
- Do they have a joint bank account?
- Do they present themselves to society as a married couple?
If ISEBA believes the couple meets these requirements, the common-law spouse may be enrolled for coverage.
Children
The following dependent children are eligible for coverage:
- Unmarried children under 25 years of age, including biological children, stepchildren, children legally placed for adoption, and legally adopted children are eligible for coverage on the employee's effective date, and are eligible until the end of the plan year in which the child turns 25 or marries.
- Newborn or Newly Adopted children are effective on the date of birth or on the date of adoption or placement for adoption (whichever is earlier).
- Unmarried children age 25 and over provided they are full-time students in an accredited school, college, or university and the member provides principal support. These dependents are eligible while attending school as well as during summer breaks, as long as they intend to return to school the following term.
- Unmarried children age 25 and over who are NOT attending school on a full-time basis are eligible until the date 90 days after the end of the calendar month in which the Dependent ceases to attend school on a full-time basis.
- Unmarried children over age 25 who are unable to support themselves due to a physical disability or mental retardation are eligible. Members must apply for this continuation within 31 days after the child reaches the maximum age.
Last updated: Tuesday, July 07, 2009 Page:
This information is not intended for use without professional advice. While we have attempted to make this site as accurate as possible, it is only a summary. For more information, see our disclaimer.