Eligibility
Who is eligible to join?
MIT, Lincoln Laboratory, and Whitehead employees who are benefits-eligible may join the Traditional MIT Health Plan and the Flexible MIT Health Plan. Draper Lab and Broad Institute employees who are benefits-eligible may join the Traditional MIT Health Plan. Retirees under age 65 may be eligible to continue with the same benefits they had while actively working. Speak with your benefits office to determine your coverage eligibility.
Eligibility categories
You may choose:
- An individual contract to cover yourself
- An employee-plus-spouse contract to cover:
- yourself
- your spouse, or your same-sex or opposite-sex spousal equivalent, if your employer provides this coverage. For more information, check with your benefits office.
- your former spouse (f you are divorced or legally separated) until one of you remarries, unless such an arrangement is specifically prohibited by a court order. If you remarry, a court order may require you to provide coverage for your former spouse as long as he or she remains unmarried. In this situation, it may be possible for your former spouse to be covered by an individual contract at the full unsubsidized cost, but only if you request this coverage through your employer’s benefits office.
- An employee-plus-child(ren) contract to cover:
- your unmarried dependent children, until the end of the month of their 25th birthday as long as they remain unmarried, live in the service area (if not enrolled as a student at an accredited degree-granting institute of higher learning), and are not eligible for coverage through an employer or other group plan. The requirement to live in the service area does not apply to members of the Flexible MIT Health Plan.
- a dependent child of one of your dependent children, but only as long as the dependent parent is eligible and remains on your contract
- an unmarried child over age 25 who is physically or mentally handicapped and therefore unable to earn his or her own living. You must apply for this special coverage through the MIT Health Plan office before the child turns 25. For details, call the MIT Health Plan office at 617-253-1322.
- A family contract to cover:
- yourself
- your spouse, or your same-sex or opposite-sex spousal-equivalent, if your employer provides this coverage. For more information, check with your benefits office.
- your unmarried dependent children, until the end of the month of their 25th birthday as long as they remain unmarried, live in the service area (if not enrolled as a student at an accredited degree-granting institute of higher learning), and are not eligible for coverage through an employer or other group plan. The requirement to live in the service area does not apply to members of the Flexible MIT Health Plan.
- a dependent child of one of your dependent children, but only as long as the dependent parent is eligible and remains on your contract.
- an unmarried child over age 25 who is physically or mentally handicapped and therefore unable to earn his or her own living. You must apply for this special coverage through the MIT Health Plan office before the child turns 25. For details, call the MIT Health Plan office at 617-253-1322.
- your former spouse (f you are divorced or legally separated) until one of you remarries, unless such an arrangement is specifically prohibited by a court order. If you remarry, a court order may require you to provide coverage for your former spouse as long as he or she remains unmarried. In this situation, it may be possible for your former spouse to be covered by an individual contract at the full unsubsidized cost, but only if you request this coverage through your employer’s benefits office.
The various eligibility categories are defined more fully in the Summary Plan Description.
The service area
When you are enrolled in the MIT Traditional Health Plan, you must obtain your medical care at the Cambridge and/or Lexington MIT Medical centers, and you must reside in the enrollment area. The MIT Health Plan enrollment area is defined as the geographic area of Massachusetts, Maine, New Hampshire, and Rhode Island. The service area for the Traditional MIT Health Plan is the Commonwealth of Massachusetts.
If you and/or your family members live permanently outside of the plan’s service area or are away from the service area for more than 90 days in a calendar year for sabbaticals, leaves of absence, extended vacations, or other reasons, you are not eligible for membership in the Traditional MIT Health Plan, but you may have the option to enroll in the Flexible MIT Health Plan instead. Members of the Flexible MIT Health Plan are not required to live within the MIT Health Plan enrollment area.
For information on other health insurance options, contact your employer’s benefits office.
Changing your coverage
As employers, MIT, Lincoln Laboratory, Whitehead, and Draper have certain rules about when you may begin, end, or change your health insurance and who can enroll as an eligible dependent. For more information, contact your employer’s benefits office.
If you are pregnant and have an individual contract with the Traditional MIT Health Plan or Flexible MIT Health Plan, you must change to a family contract within 31 days of the child’s birth, so you have adequate insurance coverage for the hospitalization. To change your contract from individual to family, contact your benefits office.
Resources
MIT Employee Health Plan
2010 MIT Traditional Health Plan brochure (PDF)
2010 MIT Flexible Health Plan brochure (PDF)
2009 MIT Traditional Health Plan brochure (PDF)
2009 MIT Flexible Health Plan brochure (PDF)
Related Links
MIT Medical service directory
MIT Employee Benefits – Health and Medical Plans
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