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File Code: ADM.DOMPARTINSPREM.POL
Approval Date: 6/4/04
Approved By: President

Domestic Partner Health Insurance Premium Reimbursement Program

Beginning July 1, 2004, the University will reimburse benefits-eligible employees for a portion of the cost of insuring domestic partners and eligible dependent children of domestic partners. This reimbursement is intended to assist employees in offsetting the cost of purchasing health and dental coverage for those individuals. This reimbursement program shall not be applicable to any employee whose domestic partner is covered by the State of Illinois plan for health, dental, and vision benefits.

The amount of reimbursement will be based on the difference between what the employee had to pay to purchase his or her partner's coverage versus the premium that the employee would pay for dependent coverage under the State of Illinois CMS plan. This amount is limited to the amount the employer would pay for dependent coverage under the State of Illinois CMS plan. This is a taxable benefit and withholding taxes will apply.

To qualify, the employee and the domestic partner must complete and submit the Western Illinois University Statement of Domestic Partnership Declaration form, a confidential form filed with the Benefits Office. (Currently, all employees are required to provide proof of dependency status documentation to enroll their dependents in benefit plans.) If an employee and the employee's domestic partner are both employees of the University or any other State of Illinois agency, or are provided health benefits through their employer, or through a group medical plan, each must be insured individually, and may not be reimbursed for their partner's health insurance premium.

If there is any change in domestic partner status, the employee agrees to notify the Benefit's Office of such change by filing the appropriate statement at the time of the change. Domestic partner benefits, including the domestic partner health insurance premium reimbursement benefit, will terminate at midnight on the date preceding the change which is consistent with state of Illinois CMS notification rules which pertain to divorce.

Health Insurance Premium reimbursements are processed on a quarterly basis. A completed Medical Premium Reimbursement claim form with documentation providing evidence that medical coverage for a domestic partner was purchased from a bonafide insurance company or HMO plan must be submitted to the Benefit's Office. Evidence of payment will include copies of canceled checks, bank statements, or payroll stubs and monthly medical premium paid (invoice or employer rate sheet) for each month/pay period.

Claim forms must be received in the Benefit's Office by the 1st of the month to be paid on the paycheck closest to the 1st of the following month:

Reimbursement Request Received

Reimbursement Request on Closest Paycheck To

November 1

December 1

February 1

March 1

May 1

June 1

August 1

September 1