Aging Out at 26 - Dependents with Disabilities
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First Published :Thu Jun 01 14:40:17 GMT 2017
Last Modified :Mon Jul 20 18:20:25 GMT 2020
Last Published :Mon Jul 20 18:20:25 GMT 2020
Information pertaining to employees who have dependents over age 26 with disabilities.
Employees can cover dependent children up to age 26 regardless of whether the child is a tax dependent, in school, or lives at home. If the enrolled employee lives in New England and if the child is enrolled but is not local to the New England area (i.e. the child goes to college in another state), services for that child rendered outside of New England would be considered out of network.
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. Note: You will see the change to your benefit deductions in the paycheck in which both pay period start and end dates are in the month after the dependent reaches age 26. If a dependent is turning 26, no documentation needed. HR adjusts employee's coverage level automatically. 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 prior to age 26.
- 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 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; Control number 46943 and the branch is 000001.
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 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.
Dependent with disability, coverage, over age dependents, over age 26