Disabled dependent

[Guest Writergal]

Hello, we are struggling with whether our definition of a disabled dependent has kept up with current benefits philosophy. Our policy allows dependent children to be covered to age 19, unless a full-time student in which they can be covered up until age 25. If the dependent child is disabled, the requirements are pretty straightforward with one exception - the plan requires that the disability occur before the maximum qualifying age - and the child needs to be covered under the plan at the time.

Example 1: Amy is a dependent child covered under the medical plan. She is going to turn 19 in 2 months. She has been physically disabled since birth. Her parents must seek certification of her disability before coverage would otherwise end for her on her 19th birthday.

Example 2: Derek is a dependent child covered under the medical plan. He is 22 years old and is also a full-time student as defined by the plan. He sustains a major injury and cannot continue with his studies for the forseeable future. He is no longer eligible to continue coverage under the plan unless his parents seek certification of his disability. If he is certified as a disabled dependent, and continues to meet the eligibility requirements, he may be covered under the plan indefinitely.

Example 3: Katie is a dependent child who is not covered under the medical plan because her father was just hired by the company. He wishes to add her to coverage. She is 27, she has always been disabled, and furthermore, she has been covered under his previous employer's plan for years. Under our plan, she is not eligible to be added to coverage, as she was not added to the plan prior to the limiting age (19 or 25).

Our question then concerns Example 3. Do your plans allow a new hire to add a disabled dependent if they exceed the maximum age at the time of enrollment?

[Mary C]

We allow new hires to add disabled dependents over the age of 19 to the plan if the disability was present before age 19. We have all applications to cover disabled dependents over the age of 19, whether they are new to our plan or just turning age 19, reviewed by an outside third party to determine disability before enrollment.