TSS - Aging Out at 26 - Dependents with Disabilities

Aging Out at 26 - Dependents with Disabilities

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First Published  :Thu Jun 01 14:40:17 GMT 2017
Last Modified  :Thu Jun 01 17:07:42 GMT 2017
Last Published  :Thu Jun 01 17:07:42 GMT 2017
Summary :  Information pertaining to employees who have dependents over age 26 with disabilities.

Response

Primary Information

    According to university benefit eligibility guidelines, dependents will no longer be eligible to participate in the university’s benefit program effective the 1st of the month after the dependent reaches twenty-six (26) years of age. The only exception to this eligibility requirement is a child who is incapable of self-support, regardless of age, due to a disability that was diagnosed prior to age 26.
    If an employee has a dependent with a disability who is going to age out of coverage eligibility, in order to continue coverage with Tufts Health Plan:
    •          The subscriber needs to contact Tufts Health Plan’s (THP) member services prior to their disabled dependent turning age 26.
    •          Member services will note that in their system and mail the attached form to the subscriber’s home address on file.
    •          The subscriber and treating physician need to complete the form and return it to THP for review/approval.
    •          THP will then notify Tufts University’s benefits team of the approval/denial.
    Delta Dental
    Delta Dental requires the attached application to be on file for any dependents that need to be flagged in their system to continue coverage past the age of 26.  There is also a disabled dependent field within the electronic enrollment file that can be checked off to indicate a dependent is disabled, but they would still ask for the attached form or some type of letter from a physician to be on file for their internal auditing purposes.
     
    Prudential – Life Insurance
    1.The employee contacts Tufts Benefits Department at least 31 days prior to the dependent child’s 26th birthday.
    2.Tufts completes “Part III” of the attached form;
    3.The form is provided to the employee for completion by the member and the Dependent’s physician;
    4.The form is sent to Prudential for review;
    5.The employee receives notification from Prudential that the Dependent has been approved to remain on the Life Insurance program beyond the age of 26;
    6.The employee provides a copy of the approval letter to Tufts. A copy of the letter is retained in the employee’s file.
     
    EyeMed
    EyeMed does not have a specific process in place as they do not audit dependents and  accept the eligibility rules determined by the client.  If a situation occurs with a disabled dependent that would need to continue coverage after 26, then we would simply continue to keep them active on the eligibility file we pass over to Eyemed and they would accept and keep the dependent as active.

     

Related Information

Information

Keywords

    Dependent with disability, coverage, over age dependents, over age 26