In general, coverage for a child will end when he or she reaches age 19. The only exceptions are if the child is a full-time student , on a church-sponsored mission, or disabled, in which case the child’s coverage can continue up to age 25 or as long as he or she continues to meet eligibility requirements. Below are additional details that pertain to this extended coverage.
Full-Time Students
If you enroll a child who is 19 years of age or over and a full-time student in health care coverage, you will be required to certify your child’s full-time student status twice per year which may include providing official documentation from the accredited college or university. A full-time student is defined as taking 12 or more hours or credits per semester. However, if the accredited school defines full-time differently, a letter or policy from the school defining full-time status will be considered for this determination. Any claims incurred on behalf of the student before proof of status is provided for that particular semester will not be paid until such proof is received.
Coverage will terminate on the last day of the month preceding the month in which the new semester begins for which the child is no longer enrolled. For example, your child was enrolled as a full time student through the end of the spring semester. The fall semester starts September 15th and your child does not enroll for the fall semester. Coverage will terminate for your child on August 31st.
For full-time students who are unable to attend or complete the current semester due to an illness or injury, please contact the Strategic Benefits Department at (214) 887-7091 for additional information regarding qualification for an extension of coverage during a student medical leave of absence.
Church-Sponsored Mission
Dependents are eligible for coverage beyond their 19th birthday if they are on a church -sponsored mission.
Disabled Children
If your child is disabled, he or she may be covered under the ACS health care plans, regardless of age. For purposes of this provision, your child is considered disabled if he or she:
- Is not able to earn his or her own living because of a physical handicap, mental illness or mental retardation that existed before the date he or she reached the maximum age of coverage (age 19 or age 25 if a full-time student); and
- Depends primarily on you for support and maintenance.
The dependent child must be disabled prior to the age of 19. If the disability occurs after age 19, the dependent must have been an eligible dependent, i.e., a full-time student or on a church-sponsored mission, prior to being disabled and the disability does not allow your child to return to school full-time or to the church-sponsored mission.
You may be required to provide proof of your child’s continued incapacity. ACS also has the right to examine your child, at its own expense, as often as needed while the disability continues. However, proof of continued incapacity and dependency will not be required more than once each year after two years from the date your child reaches the otherwise maximum age for coverage.
Your disabled child’s coverage will end on the earliest of the date:
- Your child is no longer disabled.
- You fail to provide proof of the continuing incapacity and dependency.
- Your child fails to undergo the required exam.
- Dependent coverage for your child is terminated for any reason other than reaching the maximum age (e.g., getting married).
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Questions about your employee benefits or other Human Resources issues? Contact the Workplace Solutions Center at (888) 471-2271.