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Dependent Coverage Mandate FAQs

Q. What is included in the Federal definition of a dependent (part of the Patient Protections and Affordable Care Act of 2010)?

A. The Federal definition varies from the State of Wisconsin's definition in that a dependent is eligible for insurance coverage until he/she turns age 26 regardless of marital status. The State Dependent Mandate has been revised to closely match the Federal Dependent Mandate as it relates to the minimum required age for plans to cover dependents. A dependent is covered on the parent's policy until the dependent turns age 26, regardless of marital status.

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Q. When can I add my newly qualified dependent to my policy?

A. Dependents not currently covered on your policy, but who now meet the new definition of a dependent, may be added to your coverage when your policy is renewed. Please contact your employer for more information on adding a dependent at renewal time.

For members on an individual policy (a policy not offered through an employer), dependents may be added upon their next renewal. Dean Health Plan will notify them of this benefit during the renewal process – approximately 30-45 days prior to the renewal date.

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Q. What do I need to do to add my dependent to my policy?

  • If coverage is through your employer, and your eligible adult child is not currently insured on the policy, you should submit an application to your employer prior to the renewal date to change from single to family coverage or to add your adult child. Coverage for your child will be effective upon your renewal date as long as it’s received by Dean Health Plan within 30 days of the effective date. Example: If your group renews January 1st, the application must be submitted to Dean Health Plan prior to January 31, to be considered timely. Your employer should be able to help you with the specifics your company’s application process.
  • If coverage is through an individual policy, you’ll need to submit an application directly to Dean Health Plan to add your dependent. Coverage for your child will be effective upon your renewal date as long as it’s received by us within 30 days of the effective date. If your premium rate is affected, we’ll let you know with the next billing statement.

NOTE: After the renewal date, you can add your adult child if there is a qualifying event. If there is no qualifying event, you can still add your adult child, but coverage is subject to a late enrollee waiting period. Establishing full-time student status is not considered a qualifying event since it’s no longer a required dependent criteria. Loss of other coverage or increase in premium cost for other coverage are examples of qualifying events.

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Q. If my dependent turns 26 before my renewal, will you terminate him/her?

A. Coverage for dependents who turn 26 prior to group renewal will end on the group renewal. For example, coverage for a 26 year old dependent whose group renews March 1, 2013 will end on February 28, 2014.

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Q. Do I have to include my dependent on my policy?

A. No. The new mandates require insurance companies to provide coverage based on the new definition, but parents are not required to cover their adult dependents unless they choose to do so.

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Q. My adult child is on COBRA continuation coverage. Can I cover him/her on my insurance?

A. Yes, as long as your adult child meets the eligibility requirements.

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Q. Does this change include my disabled dependent?

A. Yes. We will have no need to confirm the disabled status of your dependent until he/she turns age 26. 

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Q. Can my dependent be covered on my policy after returning from active duty in the military?

A. A dependent under age 26 and called to federal active duty can be reinstated to the parent’s plan upon return from active duty. Further, dependents returning from duty after age 26 can be reinstated to their parents’ plan if they were a full-time student before military service and they re-enroll as a full-time student after military service.

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Q. If my dependent gets married, can he/she stay on my policy?

A. This depends on plan design. Please check your member certificate.

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Q. Why didn’t I receive a dependent verification form this year?

A. Since the verification process was largely based on validating full time student status and support from parents, it is no longer needed.

We may have to confirm full-time student status in limited cases where the military service provision may apply but we will do that on a case by case basis.

Note: State and Local government (Employee Trust Funds program) employees are required to provide additional student verification. For more information, please see the Department of Employee Trust Funds website. Federal employees should also refer to their benefit materials for information on dependent coverage guidelines.

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Q. Can the spouse of a married adult dependent be covered on this plan as well?

A. No, the adult dependent only, can be covered under the parent's plan.

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