Information pertaining to employees who have dependents over age 26 with disabilities.
Aging-Out-at-26-Dependents-with-Disabilities
Dependent with disability, coverage, over age dependents, over age 26
Response
Employees can cover dependent children up to age 26 regardless of whether the child is a tax dependent, in school, or lives at home.
Effective the 1st of the month after the dependent reaches twenty-six (26) years of age dependents are no longer eligible to participate in the university’s benefits program. Sixty (60) days before their dependent turns 26, PeopleSoft auto-emails the employee notifying them that their dependent’s health/dental/vision/life coverage will terminate on the last day of the month that they turn age 26. If a dependent is turning 26, no documentation is needed. HR adjusts employees' coverage levels automatically. When the coverage changes, the employee will see the change to their benefit deductions in the paycheck in which both pay period start and end dates are in the month after the dependent reaches age 26. COBRA enrollment paperwork will automatically be sent by EBPA.
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 before age 26 for health, dental, vision, and dependent life insurance.
PeopleSoft Disabled Dependent Flag
The employee contacts the TSS and the case is escalated to HR Benefits at least 31 days before the dependent child's 26th birthday.
TSS T-1 escalates the case to HR Benefits.
HR Benefits provides the employee with information about how to request approval from applicable vendors (see below).
If the vendors approve disability, the case is assigned to TSS to update the PeopleSoft disabled dependent flag and update the health/dental/vision/life plan records if needed.
Disabled dependent flag information is captured on the health, dental, and vision plan vendor file feeds, and the dependent remains enrolled in the plans.
BCBS Health Plan
HR Benefits advises the employee (subscriber) to contact BCBS before their disabled dependent turns age 26.
BCBS mails the attached form to the subscriber’s home address on file.
The subscriber and treating physician complete the form and return it to BCBS for review/approval.
BCBS notifies the HR Benefits of the approval/denial.
If approved, HR Benefits requests TSS update the PeopleSoft “disabled dependent” flag
CVS Caremark (pharmacy for BCBS enrollees)does not require information from the subscriber. Dependents who have the Disabled Dependent Flag in PeopleSoft will remain enrolled and on the file feed sent to the vendor.
Delta Dentaldoes not require information from the subscriber. Dependents who have the Disabled Dependent Flag in PeopleSoft will remain enrolled and on the file feed sent to the vendor.
EyeMed does not require information from the subscriber. Dependents who have the Disabled Dependent Flag in PeopleSoft will remain enrolled and on the file feed sent to the vendor.
Unum – Dependent Life Insurance
The employee contacts the TSS and the case is escalated to HR Benefits at least 31 days before the dependent child's 26th birthday.
HR Benefits completes Page 1 of this form; Policy number 955632 and provides it to the employee for completion by them and the dependent's physician.
The employee sends the form to Unum for review/approval. Unum may request copies of guardianship and/or medical records.
The employee receives notification from Unum that the dependent has been approved to remain on the life insurance program beyond the age of 26.
The employee provides a copy of the approval letter to Tufts. A copy of the letter is retained in the employee's file.
