Updated page (January 24, 2013)
As part of the Affordable Care Act (ACA - federal health reform), coverage for dependent children has been extended to the age of 26 effective July 1, 2011. Family coverage is required to add your dependent to health and/or GIC Dental/Vision coverage. If your dependent is already enrolled in GIC coverage and is turning age 19, the GIC will extend coverage to age 26 and send you a letter two months prior to the dependent turning age 19.
Q) Who qualifies as a dependent under ACA?
A) The definition of a dependent under federal health reform is a son, daughter, stepson, stepdaughter, adopted child, or eligible foster child. To be eligible for coverage as a foster child, the child must be placed by an authorized placement agency or by judgment, decree, or other order of any court of competent jurisdiction.
Q) My IRS dependent is not one of the relationships listed above. Is he/she still eligible for coverage?
A) Your dependent may be eligible for health coverage under state law, which provides for coverage for two years after loss of IRS dependent coverage or age 26, whichever occurs first. Contact the GIC at extension 5 for the Massachusetts Health Care Reform Dependent Age 19 to 26 form.
Q) My child is turning age 19. How can he/she continue health and/or dental/vision coverage?
A) When your child turns age 19, your child will be eligible for coverage up to the last day of the month your dependent turns age 26 as long as you, the insured, have family coverage. The GIC will send you a letter two months before your child turns 19 notifying you of this extension. Complete and return the form portion of this letter to the GIC if your child is a full-time student at a school outside of the health plan's service area or a non full-time student who lives out of the health plan's service area, retaining a copy for your records.
Q) Who is considered a full-time student?
A) To be eligible for coverage as a full-time student, the dependent must attend an accredited college or university, vocational or secondary school on a full-time basis.
Q) My child is between the ages of 19 and 26 and is not currently enrolled in GIC health and/or dental/vision coverage? How can I enroll my dependent in coverage?
A) If your child is between age 19 and 26 and is not currently enrolled in GIC coverage, apply for coverage by completing and returning to the GIC the Dependent Age 19 to 26 Enrollment and Change Form. The GIC will determine coverage eligibility and the effective date.
Q) What documentation must I submit with my dependent's application?
A) If you have not previously submitted the following documentation, it must accompany the Dependent Age 19 to 26 Enrollment and Change Form:
- Children/stepchildren: photocopy of birth certificate showing parent-child relationship of insured or insured's spouse
- Adopted children: photocopy of proof of placement letter or adoption
- Foster child: photocopy of proof of placement letter or court order
Q) My child is disabled and is ages 19 to 26. How do I cover him or her?
A) If your child is mentally or physically incapable of earning his/her own living and the child's disability occurred prior to age 19, you can apply for handicapped dependent coverage by completing and returning the GIC Handicapped Dependent application, available on the forms section of the website. Coverage may continue as long as the handicapped dependent remains unable to support him/herself due to disability and you continue on GIC family health coverage. Be sure to respond to the GIC's periodic handicapped re-certification requests to ensure uninterrupted coverage for your dependent.
Q) My full-time student goes to school outside of our health plan's service area. May we remain in our current health plan?
A) You may remain in your current health plan for as long as your dependent is a full-time student and enrolled in GIC coverage as a full-time student. However, if your child under age 26 ceases to be a full-time student, complete and return the Dependent Age 19 to 26 Enrollment and Change Form; the dependent must reside within the health plan's service area to be covered. If your dependent is not one of the relationships listed under the first question, complete and return to the GIC the Massachusetts Health Care Reform Dependent Age 19 to 26 Form, available by calling the GIC at extension 5.
Q) If my dependent age 19 to 26 is covered as a full-time student is he/she covered during the summer months?
A) Your student dependent is covered during the summer only if he/she was enrolled as a full-time student for the entire spring semester and is enrolled as full-time student for the following fall semester. If your dependent is not returning to school in the fall, complete the Dependent Age 19 to 26 form to continue the dependent's coverage under ACA.
Q) My full-time student-dependent is going on a medical leave, withdrawing from class, graduating, or returning to school part time. What happens to his/her coverage?
A) Your child can continue to have GIC coverage up to the age of 26. The dependent must live in your health plan's service area. Notify the GIC of the dependent's status change by completing and returning to the GIC the Dependent Age 19 to 26 Enrollment and Change Form. If your dependent is not one of the relationships listed under the first question, complete and return to the GIC the Massachusetts Health Care Reform Dependent Age 19 to 26 Form, available by calling the GIC at extension 5.
Q) My dependent age 19 to 26 lives outside of our health plan's service area. May we stay in the same health plan and enroll our dependent in coverage?
A) No. If a family member moves or resides outside of a health plan's service area and is not a full-time student ages 19 to 26, the entire family must enroll in the UniCare State Indemnity Plan/Basic, which is the only GIC employee health plan available throughout and outside of the United States. The only exception is for dependents who are full time students; see preceding question and answer.
Q) My child age 19 to 26 is working and is eligible for coverage through his/her employer. Is my child eligible to enroll in my GIC family health plan?
A) Yes. Your dependent may enroll in GIC coverage up to the age of 26 providing he/she lives in your health plan's service area. Alternately, he/she may enroll in his/her employer's health plan.
Q) My full-time student is turning 26. What happens to his/her health coverage?
A) Your dependent can continue health coverage until he/she ceases to attend school full time. However, you must pay 100% of the premium.
Alternately, if your child is a Massachusetts resident, he/she may purchase health insurance from the Health Connector (1-877-623-6765).
Q) I am enrolled in the GIC Dental/Vision plan. How do I enroll my child age 19 to 26 in dental/vision coverage?
A) Complete and return the Dependent Age 19 to 26 Enrollment and Change Form to add your child to health and/or dental/vision coverage. Note that you must have family dental/vision coverage to add your dependent to this coverage. The form is available on the forms section of the GIC's website.
Q) Can I drop my child age 19 or over from GIC coverage?
A) You may drop your child age 19 or over from GIC coverage at any time, but please be aware that in Massachusetts, your child must have health insurance. If an individual fails to obtain health insurance coverage, he or she will be subject to Massachusetts Department of Revenue penalties. You must write to the GIC to request that the dependent ages 19 or over be removed from your GIC coverage. Include your name, your GIC Identification number (usually your Social Security Number, not your health plan ID number), and your dependent's name and date of birth. If you are covering no other dependents or a spouse or former spouse, you may change to individual coverage by submitting your request with the letter asking to drop your dependent.
This information provided by the Group Insurance Commission.