· Definition of an Eligible Child
· Age Requirements
· When Coverage Ends
Definition of an Eligible Child
If you have insurance through your employer, these rules apply in deciding whether they are eligible for coverage under your insurance.
Employee Coverage
| Type of Child | Requirements |
| Natural Child, Stepchild, and/or Adopted Child |
|
| Child Placed with You for Adoption, Child of a Domestic Partner, Any Child Related to You Directly or by Marriage,
Legal Guardianship Qualified Medical Child Support Order (QMCSO) or Office of Support Enforcement, Other Than Your Natural Child, Adopted Child, or Stepchild |
|
When you add your child to your coverage, you’ll probably be required to verify your child’s dependent status with documentation.
Children may be eligible to continue coverage beyond age 26 if they’re disabled.
Newborn children are usually covered for some period of time after birth but then must be added to your insurance to be eligible for coverage if your employer offers it.
Age Requirements
Some states have dependent age exception laws that extend eligibility beyond national eligibility rules. These rules only apply to medical coverage. Not all states with these exceptions are listed. Contact your local state insurance commissioner’s office to determine where you can find out whether the dependent eligibility rules are different for your state.
The following rules for dependent age eligibility are based on the employee’s home ZIP code.
| State | Maximum Age Less Than or Equal to | Eligibility Rules |
| Florida | 30 | Coverage must last until the end of the calendar year in which dependents turn age 30, as long as they continue to meet the eligibility rules above. |
| North Dakota | 26 | Coverage must last until the dependent’s 26th birthday, regardless of student status, as long as he or she continues to meet the other eligibility rules above. |
| Utah | 26 | Coverage must last until the dependent’s 26th birthday, regardless of student status, as long as he or she continues to meet the other eligibility rules above. |
| Illinois | 26 | If you’re enrolled in a fully insured medical or dental plan, coverage must last until the dependent’s 26th birthday.He or she must be unmarried and be principally supported by you. |
| 30 | If you’re enrolled in a fully insured medical or dental plan, coverage last until the dependent’s 30th birthday if the dependent meets both of these requirements:1. He or she is a resident of the state.2. He or she served as a member of the active or reserved components of any of the branches of the U.S. Armed Forces and has received a release or discharge other than dishonorable discharge.
Principal support rules apply. |
|
| New Jersey | 30 | Coverage must last until the dependent’s 31st birthday, regardless of student status, as long as he or she continues to meet the other eligibility rules above. |
When Coverage Ends
Dependent eligibility ends on the last day of the month in which the dependent no longer meets the eligibility requirements, as stated above.
You should notify your employer’s benefits department promptly when your dependent loses eligibility. This will ensure that you are refunded for any deductions that are paid after that date. There are probably time limits on notification and reimbursement.
We updated this information on March 15, 2O11. We’ve made every effort to make certain that it is accurate but it is not your official summary plan description. To obtain a copy of this document, contact your company’s benefits department.
Go Mobile