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American Family Children's Hospital

Domestic Partner Information Sheet

 

Same-sex and opposite-sex domestic partners are treated similarly to spouses for our benefit plans administered by the Department of Employee Trust Funds (ETF) as well as many of our optional benefit plans. Dependent children of your domestic partner are also eligible for benefits.

 

Domestic partners must meet all of the following conditions:

  • Be at least 18 years of age and otherwise competent to enter into a contract;
  • Neither individual is married to or in a domestic partnership with another person;
  • Neither individual is related by blood in any way that would prohibit marriage under Wisconsin law;
  • The two individuals consider themselves to be members of each other’s immediate family;
  • The two individuals agree to be responsible for each other’s basic living expenses;
  • The two individuals share a common residence.

Please access the ETF Domestic Partner Toolkit and Frequently Asked Questions (FAQs) to learn more about domestic partner eligibility, requirements for benefit coverage and effective dates.

 

To establish a domestic partnership for benefits, you must meet the eligibility criteria for domestic partnership and submit a completed and notarized Affidavit of Domestic Partnership (ET-2371) to ETF. ETF will acknowledge your affidavit with a letter and provide you with the date of your established domestic partnership. Please note there is no connection between the State of Wisconsin Domestic Partner Registry and the domestic partner benefits administered by ETF and UW Hospital and Clinics under Wisconsin chapter 770.

 

Once your domestic partnership is established, your domestic partner and his/her dependent children may be eligible for the following benefits: health, supplemental Delta Dental, VSP Vision Care, EPIC Benefits+, State Group Life (SGL) Spouse/Dependent coverage, Supplemental Life Spouse/Dependent coverage and Wisconsin Retirement System and Wisconsin Deferred Compensation program survivor benefits. Please see below for specific information on how to enroll your domestic partner and his/her eligible dependents in your benefit plans.

 

Tax Implications

 

If your domestic partner or your partner's eligible dependents are not considered tax dependents for health insurance purposes under federal law, the Fair Market Value (FMV) of the UW Hospital and Clinics contribution toward their health insurance coverage is considered a taxable fringe benefit, must be added to your earnings as imputed income and is subject to tax withholding. The monthly Imputed Income Amounts vary by health plan. Please note that the imputed income amounts will be adjusted annually. If your non-tax dependent domestic partner and his/her eligible dependents are enrolled in your Supplemental Delta Dental or EPIC Benefits+ or VSP Vision, the benefit premiums for these insurances will be deducted from your paycheck post-tax.

 

You are responsible for determining the tax dependent status of your domestic partner and his/her eligible dependents when you add them to your insurances. In order to be considered a tax dependent, your domestic partner must meet the federal qualifications for a "qualifying relative." Consult IRS Publication 501 or the IRS Form 1040 Instructions, pages 17-20, for more information.

 

In general, the IRS requires that a "qualifying relative" meet four tests:

  1. The person does not meet the "qualifying child" tests;
  2. The person must live with you all year as a member of your household (and your relationship must not violate local law);
  3. The person’s gross income must be less than $3,650 for the year. (However, under Internal Revenue Service Notice 2004-79, this gross income limit does not apply for purposes of determining tax dependent status when you are covering the person on your health insurance policy. For health insurance purposes, the domestic partner only needs to meet the remaining three tests to be a qualifying relative).
  4. You must provide more than half of the person’s support for the year.

The list above should not be used as the sole source of information for determination of your domestic partner’s tax status. UW Hospital and Clinics staff cannot provide tax advice. The IRS's tests are described in detail in IRS Publication 501. In addition, you should consult with your tax advisor or the IRS if you have questions on how the federal rules apply to your situation.

 

For additional information to help you determine if your domestic partner is considered a tax dependent, please review page 5 of ETF’s Domestic Partner Benefits Brochure and  ETF’s Domestic Partner Frequently Asked Questions (FAQs). Please consult your professional tax advisor before adding a domestic partner to your benefits to fully determine how your specific tax situation may be affected.

 

To Establish your Domestic Partnership and Enroll your Domestic Partner and and His/Her Dependents in Benefits

  • Please review ETF’s Getting Started with Domestic Partner Benefits and their Domestic Partner Benefits brochure.
  • Submit a completed and notarized Affidavit of Domestic Partnership (ET-2371) to ETF. Keep a copy of the affidavit for your records.
  • Submit a copy of your domestic partnership acknowledgement letter from ETF and a copy of your Affidavit of Domestic Partnership (ET-2371) to Human Resources within 30 days of the date of domestic partnership provided to you on your acknowledgement letter.
  • Health Insurance:
  • Supplemental Delta Dental, VSP Vision Care and EPIC Benefits+: Submit the applicable benefit applications to Human Resources within 30 days of the date of domestic partnership provided to you on your acknowledgement letter.
  • State Group Life (SGL) Spouse/Dependent insurance:
    • If you are currently enrolled in SGL Spouse/Dependent coverage, your domestic partner and his/her eligible dependents will automatically be covered as of the date of your domestic partnership determined by ETF. You do not have to submit a benefit application for coverage.
    • If you are currently enrolled in SGL Employee coverage but not enrolled in SGL Spouse/Dependent coverage because you had no qualified dependents, submit a copy of your Affidavit of Domestic Partnership (ET-2371) at the same time you submit your State Group Life Insurance Application to Human Resources. Both must be received within 30 days of the date you submit your Affidavit of Domestic Partnership (ET-2371) to ETF. Do not wait to submit this document until you receive your acknowledgement letter from ETF. Once you receive your acknowledgment letter from ETF, submit a copy to Human Resources.
    • If you are currently enrolled in SGL Employee coverage but not enrolled in SGL Spouse/Dependent coverage but have a qualified dependent(s), this is not an enrollment opportunity for you. You must go through medical underwriting to add Spouse/Dependent coverage.
  • For your convenience, links to the benefit applications are included at the end of this document.

Annual Opportunity to Change Domestic Partner Health Coverage 

 

The annual It’s Your Choice enrollment period gives employees an opportunity to enroll or disenroll an established domestic partner and his/her eligible dependents in health insurance coverage as of January 1 of the following calendar year.

 

To add or remove your previously established Domestic Partner and his/her eligible dependents to your health insurance coverage, submit a Health Insurance Application/Change Form to Human Resources between October 8, 2012 and November 2, 2012.

 

Please see ETF's Domestic Partner Frequently Asked Questions (FAQs) for additional information on other qualifying events that would allow you to enroll or disenroll a domestic partner mid-calendar year.

 

Benefit Applications and Other Important Domestic Partner Resources