Verify adult dependent children’s eligibility for continued insurance coverage

Do you have dependent children on your health insurance policy who are 19 years or older? If yes, please read this email carefully.

The Department of Employee Trust Funds (ETF) requires health plans to annually verify eligibility of adult children for health insurance. In November, your health plan will mail you a letter and an Adult Child Eligibility Form. If your adult child is eligible in 2010, and you want to continue to cover your adult child on your health insurance policy in 2010, you must return the completed form to your health plan by December 1, 2009. Even if you switched health plans during the “It’s Your Choice” enrollment period, return the completed form to the health plan in which you are currently enrolled.

If you do not return the completed form to your health plan, your adult child’s health insurance coverage ends on December 31, 2009. You will not be able to add the child back on to your coverage during 2010 unless s/he has a qualifying event such as loss of other comparable health insurance coverage. A return to school as a full-time student is not a qualifying event.

IMPORTANT CHANGES: The Office of the Commissioner of Insurance has issued an emergency administrative code to clarify when an adult dependent child loses eligibility for health insurance as a dependent under their parents’ health insurance plan:

• The end of the month in which the adult child turns age 27;
• The end of the month in which the adult child marries;
• When the child is eligible for health insurance through his/her own employer that has a lower employee cost than the cost to provide coverage through a parent’s plan.

This is a change from the comparing the cost of the health insurance coverage of the adult child through his/her own employer to the fair market value of the coverage through his/her parent.

Because of this change, covered employees may enroll eligible adult children for health insurance, as well as EPIC, Anthem DentalBlue and VSP, through the end of 2009 for coverage effective January 1, 2010.

This change has created an enrollment problem for adult children who would have lost eligibility for coverage at the end of 2009 had the coverage to age 27 mandate not been passed and:

• Who are eligible for State Group Health because they are eligible WRS employees or eligible Graduate Assistants; but

• Did not enroll in health insurance due to coverage under a parent’s policy through the state.

There will be a one-time exception whereby any adult children insured on their parent’s policy will have an enrollment opportunity through their own WRS employer for coverage effective January 1, 2010. The enrollment deadline is December 30, 2009. Please be aware that UW-Madison is closed for a mandated furlough day on December 30, 2009, so enrollment forms must be submitted by December 29, 2009.

If you have questions, please email
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