Health Plans

Medical coverage is available to all individuals and their dependents who are eligible for health benefits. These benefits are offered through the State of Maryland Employee Benefits Division.

Types of Plans

There are three types of medical plans offered: Preferred Provider Organization (PPO), Exclusive Provider Organization (EPO) and Integrated Health Management (IHM). While all three types of plans offer comprehensive coverage, the type of medical plan you choose determines your premium, out-of-pocket expense, and choice of physician. Please remember that any medical treatment must be considered a “medical necessity” by your plan in order for payment to be authorized. The Summary of Benefits and Coverage provides a general overview of the differences in types of plans from Kaiser, Carefirst and United Healthcare. Please consult the official Benefits Guide Book for complete plan details.

Employees

Any regular employee, working at least 50 percent (50%) of the time is eligible to participate in the University’s benefit programs. Retirees from such positions may also be eligible based on their years of service at the time of direct retirement from the University. Graduate Assistants are also eligible for most health benefit plans with the exception of the state-sponsored retirement plans.

Contingent I and Contingent II employees working over 30 hours a week (75 % FTE) or more may be eligible for subsidized benefits. Contingent employees working less than 30 hours a week may be eligible for unsubsidized benefits. Learn more about Contractual Benefits.

Eligible Dependents

The spouse and eligible children of employees qualify to enroll in coverage with the appropriate documentation (see benefits guide). An “eligible child” is defined as a one of the following until the end of the month in which the child turns age 26:

• A Biological Child
• A Legally Adopted Child
• A Step-child
• A Grandchild*
• A Legal ward*, Testamentary, or Court appointed guardian (not temporary for less than 12 months)
• A Step-grandchild or other dependent child relative
• A Child over the age of 26 and incapable of self-support due to mental or physical incapacity incurred prior to age 26

*Please refer to your benefit guide book for important tax information.

Note: A husband and wife who are both State employees may NOT have duplicate coverage under any plan by covering each other under separate enrollments. Also, children of a husband and wife who are both State employees may NOT be covered twice under both parents’ plans.

Open Enrollment
Once a year, typically in October, there is an open enrollment period which allows all eligible employees to change, cancel or add to existing coverage. For example, you can change from one health insurance company to another during this time, or you can cancel coverage altogether.

Changes in Coverage Due to Qualifying Events
Once you have elected a plan, you must stay in the selected plan, at the selected coverage level, for the full calendar year, unless there has been a qualifying event.

A qualifying event is a change in family status, such as:

• birth of a child
• loss of a dependent
• marriage
• loss of coverage through a spouse or parent

You have 60 days from the occurrence of the qualifying event to make changes to your benefits. The changes made, however, must be because of and consistent with the change in status that has occurred.

For a detailed guide on how to initiate a Qualifying Life Event in SPS Workday, please visit the following page.