Spouse/Domestic Partner Health Plan Eligibility Form Required if an employee elects to cover a spouse or domestic partner on the College's health, dental, or vision plan(s). Spouse/Domestic Partner Coverage Rule * RequiredMany family units include two working adults who each have access to a health, dental and/or vision plan partially paid for by their employer. Employers, including Kalamazoo College, take the approach that each employer should accept primary coverage responsibility for their own employees. An employed spouse or partner of a Kalamazoo College faculty or staff member who has health, dental, and/or vision insurance coverage available through his/her/their own employer, and that employer contributes at least 50% of the cost of coverage, may enroll as a dependent in Kalamazoo College’s health, dental, and/or vision plan(s) only if he/she/they is enrolled for primary coverage through his/her/their employer. I understand and will comply.Employee's Name * Required First Last Spouse/Domestic Partner's Name * Required First Last Is your spouse/domestic partner employed? * Required Yes No What is the name of your spouse/domestic partner's employer? * Required Does your spouse/domestic partner have group health coverage available through his/her/their employer? * Required Yes No Does that employer pay at least fifty percent (50%) of the cost of coverage? * Required Yes No Is your spouse/domestic partner enrolled in that coverage? * Required Yes No Signature Δ
