Eligibility FAQs
Eligibility FAQs
Who is eligible for LAwell benefits?
Your eligibility for LAwell benefits is evaluated on a biweekly basis, each and every pay period as follows:
Minimum Compensated Hours – You must have a minimum number of compensated hours (such as HW, SK, VC, etc.) based on your employment status as follows:
- Full-time employees – at least 40 hours
- Half-time employees – at least 20 hours
Retirement Contribution – You must continue to be a contributing member to the Los Angeles City Employee’s Retirement System (LACERS) or, if authorized by your Memorandum of Understanding, Los Angeles Fire & Police Pensions (LAFPP).
Eligible Employment Status – You must remain in a job classification and employment type that is authorized to receive LAwell benefits.
Who can I cover as a dependent?
If you are eligible for LAwell benefits, you can also cover:
A Spouse
- Your same sex or opposite sex spouse is eligible if you provide a valid marriage certificate.
or a Domestic Partner (DP)
- Your same sex or opposite sex DP is eligible if your City of Los Angeles Domestic Partnership Affidavit is approved or you provide a copy of your Declaration of Partnership filed with the California Secretary of State.
and/or a Child:
- Your dependent children up to age 26 – including your spouse/domestic partner’s children with copies of birth certificates, adoption, or other court papers.
- Your legal custody and/or foster children up to age 26 – if you provide the Employee Benefits Division with copies of court papers
- Your grandchildren – if the parent is your dependent child up to age 19, or up to age 26 for a full-time student with valid proof of student status.
- Your disabled child of any age – who is dependent on you for support and certified as disabled each year by the insurance company for your health plan.
Special Situation Child Rule: If your child is also a LAwell eligible City employee, he/she must enroll into his/her own LAwell coverage and cannot be covered as your dependent.
What happens when my child turns age 26?
Your dependent child's coverage will end on the last day of the month in which your child turns age 26. A COBRA notice will be provided to your child within 45 days of coverage termination.
Disabled Child coverage: Children with disabilities can remain your covered dependent after turning age 26 only if your LAwell health plan has certified the dependents disability.
Grandchild coverage: Coverage for grandchildren will end when the parent child reaches age 19 or age 26 if a full-time student.
What is an ineligible dependent?
The following are examples of individuals who are not considered eligible dependents:
- Your spouse following a divorce
- Someone else’s child (such as your nieces or nephews), unless you have been awarded legal custody or guardianship
- Your parents, parents-in-law, or grandparents, regardless of their IRS dependent status
NOTE: If your eligible dependent becomes ineligible (Example: Divorce, loss of custody, etc), you must drop coverage for the ineligible dependent within 30 days of the date he or she loses eligibility.
What documents support my dependent?
The following chart describes eligible dependents and samples of supporting documents for LAwell coverage:
| Dependent Type | Age | Eligibility Definition | Documents Required for Verifying Eligibility |
|---|---|---|---|
| Spouse | N/A | Person of the opposite or same sex to whom you are legally married | Marriage certificate |
| Domestic Partner | N/A | Meet City’s domestic partner eligibility requirements. See Domestic Partnership Information Sheet and Affidavit form at keepingLAwell.com | City of Los Angeles Affidavit of Domestic Partnership, or Declaration of Partnership filed with the California Secretary of State |
| Biological Child (Natural child) |
Up to age 26* | Employee’s married or unmarried child(ren) under age 26 | Child’s birth certificate, hospital verification of birth, or court document that verifies your relation to the child (an abstract document is not sufficient in most cases) |
| Stepchild | Up to age 26* | Employee’s spouse’s married or unmarried child(ren) under age 26 | Child’s birth certificate and certificate showing spouse/domestic partner as parent |
| Adopted child or child placed for adoption |
Up to age 26* | Minor or adult child legally adopted by employee, foster child, or child placed for adoption with employee under age 26 (married or unmarried) |
Child’s birth certificate and court documentation |
| Child of Domestic Partner |
Up to age 26* | Minor or adult child of employee’s domestic partner under age 26 (married or unmarried) |
Child’s birth certificate and City of Los Angeles Domestic Partner Affidavit or Declaration of Partnership filed with the California Secretary of State |
| Disabled Child | Age 26 and older | Disabled child over the age of 26 who is dependent on you for support and was disabled before age 26. To be eligible, your child must remain unmarried, dependent on you for financial support, and disabled as determined by your health plan. | Birth certificate and disability application from your health plan, completed by your child’s doctor and returned to your health plan for approval each year, or as requested by the insurance company |
| Child under a legal guardianship |
Up to age 26* | Child (unmarried) up to age 26 if you show proof of legal custody | Child’s birth certificate and court documentation |
| Grandchildren | Up to age 26* | Your grandchildren can be added to the plan if their parent is your child who • is under age 19, unmarried, and financially dependent on you or •is age 19-26 and meets the full-time student status, is unmarried, and financially dependent on you If coverage for your child ends, coverage for your grandchildren will end. |
Child’s and grandchild’s birth certificates; valid proof of dependent status and/or full-time student certification for your child |
To confirm if additional action is required for your Open Enrollment elections, review your confirmation statement.
Where can I find my Open Enrollment / Life Change Confirmation statement?
To access your confirmation statement online:
• Log into your 'Benefits Central Portal' account
• Select the “My Forms and Documents” tile
• Download your “AE Confirmation Statement (Civil & Sworn)” from
the Forms menu