| Certifying coverage eligibility for dependents age 19 and up to 24 |
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Members must certify coverage eligilibity of dependents age 19 and up to 24
If you cover a dependent age 19 to 24, you need to certify that you anticipate the dependent will be eligible for coverage in the coming plan year. You can do so on enrollment forms, update forms or the dependent certification form, which are posted on the forms page of this Web site.
Definition of "Dependent Child"
Following is the text of the definition of Dependent Child, from OAR 101-010-0005 Definitions, currently filed as a temporary rule with the Oregon Secretary of State
"Dependent child" means any child who meets the criteria in this section. In defining dependent child, PEBB follows Internal Revenue Code (IRC) 152 as revised by the Working Families Tax Relief Act of 2004:
(a) The child is not married and does not have a domestic partner; and
(A) Is under the age of 19 at the end of the calendar year; or
(B) Meets the IRC 152(f)(2) definition of a dependent child between the ages of 19 and up to age 24 attending school full time, excluding foreign students; or
(C) Is between the ages of 19 and up to age 24, living in the home of the eligible employee over six months of the calendar year, and the eligible employee provides over half the yearly support; or
(D) Is between the ages of 19 and up to age 24, and is incapable of self-sustaining employment because of a developmental disability, mental illness, or physical disability. The attending physician must submit documentation of the disability to the insurance plan for approval. Once certified, the insurance plan may review dependent certification to determine continued eligibility; or
(E) Is a child age 24 or older, and is incapable of self-sustaining employment because of a developmental disability, mental illness, or physical disability. Except in the case of a child who previously qualified under (a)(D) of this section, the attending physician must submit documentation of the disability to the insurance plan for approval. The insurance plan may review dependent certification to determine continued eligibility. If the child is terminated from PEBB insurance coverage after age 24 for any reason, the eligible employee cannot re-enroll the child. A disabled dependent child, age 24 or older, must also meet the following criteria:
(i) The disability must have existed prior to attaining age 24.
(ii) The child must have had continuous medical insurance coverage, group or individual, prior to attaining age 24 and until the time of the PEBB insurance effective date.
(b) The child must not qualify as any other person's dependent child, except that a child of divorced or separated parents meeting conditions under IRC 152(e) can be treated as a dependent of both parents.
(c) A dependent child must also meet one of the following criteria:
(A) Is a biological child of, an adopted child of, or a child placed for adoption with the eligible employee, spouse, or domestic partner; or
(B) Is a legal ward by court decree, a dependent by Affidavit of Dependency, or is under legal guardianship of the eligible employee, spouse or domestic partner, and is living in the home of the eligible employee.
(d) A child of a domestic partner meeting the definition of a dependent child is eligible to receive insurance coverage subject to imputed value tax. A valid Affidavit of Domestic Partnership must be on file with the agency for a domestic partner’s child meeting the qualifications of a dependent child.
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