Eligibility and Coverage Scenarios
Updated on November, 2017
As part of federal health care reform, coverage for dependent children was 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 the end of the month your dependent turns age 26.
Eligible dependents under the dependent age 19-26 expansion
The definition of a dependent under the dependent age 19 to 26 expansion 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.
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 617-727-2310, extension 5 for the Massachusetts Health Care Reform Dependent Age 19 to 26 form.
Children turning age 19 and how he/she can continue health and/or dental/vision coverage
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. For health plan service area details, see the attached health plan service area or your GIC Benefit Decision Guides .
Eligible full-time students
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.
How to enroll your child between the ages of 19-26 in GIC coverage
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/Change Form. The GIC will determine coverage eligibility and the effective date.
Dependent application mandatory documents
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
How to cover disabled children ages 19-26
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. 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.
If your full-time student goes to school outside of our health plan's network you may remain in your current health plan
Your family may remain in your current health plan for as long as your child is a full-time student. Contact your health plan for full-time student coverage information. If your child age 19 – 26 ceases to be a full-time student, complete and return the Dependent Age 19 to 26 Enrollment/Change Form to notify the GIC of the change. Non-student adult children age 19 – 26 may reside outside of your plan’s service area but will be subject to the plan’s coverage rules. Be sure to review your plan’s out of service area coverage and consider whether you should change to a plan providing greater geographical coverage for your dependent. Requests for health plan changes are made on a prospective basis; retroactive coverage changes are not allowed.
All full-time students have urgent and emergency care coverage. Some GIC health plans require students to receive routine care when they return home to the service area. Other GIC plans offer out-of-area network providers where full-time students can receive routine care. Check with the individual plans for additional details.
Your student dependent is also 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 federal health care reform.
If your child age 19 – 26 ceases to be a full-time student, complete and return the Dependent Age 19 to 26 Enrollment/Change Form to notify the GIC of the change. Your dependent will continue to be eligible for coverage up to the last day of the month your dependent turns age 26, as long as, you the insured, have GIC family coverage.
For dependents age 19 to 26 living outside of your health plan's service area
If your dependent age 19-26 lives outside the health plan’s service are you should review the plan’s out of service area coverage and consider whether you should change to a plan providing greater geographical coverage for your dependent. Requests for health plan changes are made on a prospective basis; retroactive coverage changes are not allowed. Keep in mind that under many plans most out of network medical care is either not covered or covered at a reduced level requiring greater out of pocket costs to you.
If your child age 19 to 26 is working and is eligible for coverage through his/her employer your child is eligible to enroll in your GIC family health plan
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. For health plan service are details, see the health plan pages or your GIC Benefit Decision Guide. Alternately, he/she may enroll in his/her employer's health plan.
Full-time student turning 26 and his/her health coverage
Your dependent can continue GIC health coverage until he/she ceases to attend school full time. However, you must pay 100% of the premium and contact the GIC at 617.727.2310 ext. 5 to arrange for this coverage.
Alternately, if your child is a Massachusetts resident, he/she may purchase health insurance from the Health Connector(1.877.623.6765). If he/she lives out of state, contact the Health Insurance Marketplace for coverage information in that state.
For covered dependents age 19-26 that are getting married, and the effect on their GIC health insurance coverage
Most dependents age 19 to 26 are covered under the insured’s family health plan. The Affordable Care Act that allows coverage for your dependent up to age 26, whether or not he/she is married. If your dependent age 19 to 26 is coverage under another status, such as full-time student, contact the GIC at 617.727.2310 ext. 5 for your dependent’s coverage options.
How to enroll your child age 19 to 26 in dental/vision coverage
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.
How to drop your child age 19 or over from GIC coverage
If your dependent has a qualifying event, you may drop him/her from your GIC coverage. You must complete the Enrollment/Change form and attach proof of the qualifying event. The GIC must receive the form and documentation within 60 days of the qualifying event. Otherwise, you must wait until Annual Enrollment to cancel the coverage.
Dependents turning age 26 health insurance options
If your dependent is a Massachusetts resident, he/she may purchase health insurance from the Health Connector (1.877.623.6765). If he/she lives out of state, contact the Health Insurance Marketplace for coverage information in that state. Alternately, he/she may elect GIC COBRA coverage.