Appendix C

Domestic Partner Policy

Effective July 1, 2005

Introduction
Same-sex domestic partners who meet the requirements of this policy shall be eligible to enroll for coverage under the health benefits plan. Opposite-sex domestic partners shall not be eligible for coverage. In the event that same-sex marriage becomes legal in the member’s state of residence, this policy may be rescinded. Domestic partners who enrolled prior to same-sex marriage becoming legal in their states of residence will be given a one-year grace period.

Basic Eligibility Requirements

• Each partner must be at least eighteen (18) years of age and competent to enter into a contract;

• The partners must not be related by blood in a manner that would bar marriage in the state of New York;

• The partners must share a common primary residence and have done so for at least two (2) years (730 days) immediately prior to the date of signing the attached affidavit;

• The partners must be in a close, committed and financially interdependent relationship;

• Neither partner may be, or have been, a member in another domestic partnership within the last two (2) years (730 days);

• The partners must file a Domestic Partner Affidavit with the member employer’s benefits office, including proof of joint residency and proof of financial interdependence. How to Enroll a Domestic Partner

To enroll a same-sex domestic partner, a member must contact his/her employer’s benefits office. Enrollment must occur during the employer’s annual open enrollment period, or within 30 days of loss of coverage under another health benefits plan due to termination of employment, reduction of hours, termination of employer contributions, exhaustion of COBRA continuation coverage, exceeding a lifetime limit on all benefits, being a member of a class of employees who are no longer eligible for benefits or change of residence to a location in which no benefits are available.

District Eligibility Requirements
Districts that participate in the Consortium have discretion over certain aspects of eligibility and cost sharing. You must contact the member employer’s benefits office for additional information.

Children of Domestic Partners
Children of eligible domestic partners may be enrolled for coverage if they meet all other criteria of the health plan, such as age and student status, and are dependents of the domestic partner in accordance with the Internal Revenue Code.

Tax Considerations
There may be federal and state tax implications for employees who enroll domestic partners in their employer’s health benefits plan. Unless the domestic partner is also a “dependent” in accordance with section 152 of the Internal Revenue Code (IRC), without regard to gross income, and you file a Dependent Tax Affidavit with the member’s employer’s benefits office, the fair market value of the coverage provided must be reported as imputed income to the employee.

The amount of the imputed income will generally be the cost difference between the premium for single coverage and the premium for family coverage.

Premium Reimbursement Accounts / Flexible Spending Accounts
Your employer may allow members to pay certain health insurance premiums and/ or unreimbursed medical expenses on a pre-tax basis though Premium Reimbursement Accounts or Flexible Spending Accounts. However, unless a domestic partner meets the definition of dependent, in accordance with the Internal Revenue Code, neither premiums paid for domestic partner coverage nor unreimbursed medical expenses of the domestic partner may be paid through these accounts.

Loss of Coverage
In the event the member loses coverage due to termination of employment or reduction of hours, the covered domestic partner, and covered children if applicable, shall be eligible for continuation coverage similar to that offered to married spouses and children under the Consolidated Omnibus Reconciliation Act (COBRA). Strict time limits apply to notification, enrollment and coverage. Please refer to the Plan Document for additional information.

Termination of Domestic Partner Relationship
In the event the domestic partnership terminates or the partner no longer meets the criteria for eligibility, the employer’s benefits office must be notified, in writing, within fourteen (14) days. If the domestic partner (and children if applicable) was covered by the Plan on the day before the relationship ended, then continuation coverage, similar to that offered to married spouses who divorce pursuant to the Consolidated Omnibus Budget Reconciliation Act (COBRA), may be offered.

A member who terminates a domestic partner relationship will not be allowed to enroll a new domestic partner for a period of two (2) years from the date the employer is notified of the termination.

Domestic partners who lose coverage under the Plan for any reason shall receive a certificate of creditable coverage from the member employer’s benefits office.

Death of Member
An enrolled domestic partner may continue coverage, similar to a surviving spouse, in the event of the member’s death. If the surviving partner marries or enters into another domestic partnership, s/he will no longer be eligible for coverage.