Insurance for Dependents

Spouse: A current legal spouse as recognized by state law. A legally separated or ex-spouse is not eligible for coverage.

Registered Domestic Partner: Individual in a current domestic partnership registered with the State of California or a substantially equivalent partnership or union, other than a marriage, validly formed in another jurisdiction.

A domestic partnership that has not been registered with the State of California must meet the following criteria to be a domestic partnership for SHIP purposes:

• parties must be each other’s sole domestic partner in a long-term, committed relationship and must intend to remain so indefinitely
• neither party may be legally married or be a partner in another domestic partnership
• parties must not be related to each other by blood to a degree that would prohibit legal marriage in the State of California
• both parties must be at least 18 years old and capable of consenting to the relationship
• both parties must be financially interdependent
• parties must share a common residence
• must fill out a Declaration of Domestic Partnership form with the Student Health Insurance Office

Children:

• Your biological child (child is eligible through the end of the month in which the child reaches age 26).
• Your legally adopted child or a child placed with you in anticipation of legal adoption (child is eligible through the end of the month in which the child reaches age 26).
• Your stepchild (child is eligible through the end of the month in which the child reaches age 26).
• Your domestic partner’s child (child is eligible through the end of the month in which the child reaches age 26).
• Your unmarried child for whom you have become legal guardian, who resides with you, is financially dependent on you for more than half of their support and maintenance, and is claimed as your tax dependent.
• Any recognized children you are required to cover under the plan due to a Qualified Medical Child Support Order (QMCSO), under age 19.
•  In most cases, a disabled child may be covered provided the disabled child meets all of the following:
• unmarried
• incapable of self-support due to a mental or physical disability incurred prior to age 26
• enrolled before age 26,
• the coverage is continuous from the date of disability
• must be approved before age 26 or by the carrier during the PIE for newly eligible employees or newly acquired dependents
• chiefly dependent upon you, your spouse or eligible domestic partner for support and maintenance (50%+ support)
• claimed as your, your spouse’s or your eligible domestic partner’s dependent for income tax purposes or, if not, is eligible for Social Security income or Supplemental Security Income as a disabled person. The overage disabled child may be working in supported employment that may offset the Social Security or Supplemental Security Income.

Please do not hesitate to contact the Student Health Insurance Office at (510) 642-5700 for further clarification.

To enroll by phone, call USI Student Insurance Monday-Friday, 8am-5pm PST toll free at (800) 853-5899.

To enroll by fax, fax an enrollment form and payment information to USI at (877) 612-7966.

To enroll by mail, mail an enrollment form and payment to:

USI Student Insurance
10940 White Rock Road, 2nd Floor, 
Rancho Cordova, CA 95670. 

You can make payment by Visa, MasterCard, Discover, Check or Money Order. Please make checks payable to USI Insurance Services National, Inc.

Fall 2018 enrollment forms:

• To enroll a dependent of an undergraduate student, use this enrollment form. 
• To enroll a dependent of a graduate student, use this enrollment form.

* Metlife caps dental premium at 1 child.

**VSP has no per child cap in premium. The semesterly $33 per child applies to the 3rd child and beyond.