Your dependent children may continue eligibility for coverage from age 19 to age 26 if they are attending an accredited high school, college, university, or trade school on a full-time basis (as defined by that educational institution). Enrollment and course load must be certified by the educational institution each year.
If your child is unable to carry a full-time course load due to an illness, injury or disability that is documented by a physician, eligibility for benefits may continue provided your child is carrying at least 60% of a full-time course load.
If your child has not graduated, he/she may miss one academic term (e.g. fall, spring, or summer), but not two consecutive terms, and still remain eligible as a dependent during that missed academic term. The beginning date for determining eligibility is the first day of the academic term following the missed term.
Your child also remains eligible for coverage if incapable of self-sustaining employment because of metal retardation, mental illness, mental disorder, or physical disability, and is chiefly dependent upon you for your support and maintenance. If your child is 19 years or older and unmarried at the time of your initial application for coverage, you must provide proof that your child meets these requirements within 30 days. Your child will then remain eligible for coverage as long as he/she continues to be handicapped and dependent.
If your child is 19 or older and not enrolled in college, or enrolled less than full-time, or if your child marries, dependent status is ended, and your child is no longer eligible to be continued on your benefits coverage.
One coverage option for your child is under COBRA continuation provisions. Dependent children who are canceled from their parents' plan can continue coverage by paying the full cost, plus any administrative fee.
To request COBRA instructions and application, notify your agency's Benefits Coordinator within 60 days from the date your child loses eligibility. Even though you have 60 days to make the election, it is recommended that you elect COBRA continuation coverage early to avoid a disruption in your child's coverage.
A qualifying event only allows you to add or delete a coverage level (i.e., Single to Family, or Family to Single coverage). A qualifying event does not allow you to change your type of coverage (i.e., PPO to Kaiser or Prepaid Dental to Regular Dental). It is the employee's responsibility to submit required documents within the time allowed (30 days). You are encouraged to contact your agency's HR Office or Plan Administrator (SBHP/FLEX) as soon as possible. Your request for enrollment or a change outside of the enrollment period will only be considered if you submit the proper documentation within the time frame allotted. To submit a request for enrollment or changes to coverage under the State Health Benefit Plan, you must submit a completed Membership or Discontinuation Form to your employer's Benefits Coordinator within 30 days of a qualifying event (unless another time period is specified). Your request for enrollment or a change in any other coverage under the Flexible Benefits Program must be submitted on the Change in Status Event Form and given to your agency's Benefits Coordinator within 30 days of a qualifying event (unless another time period is specified). If you fail to submit required documents within the time period allowed, you will not be able to make changes until the next Open Enrollment Period.
Generally, any changes will go into effect the first of the month following the date when the payroll deduction is changed to reflect your new choice.
If you have questions regarding a change in any of your coverages, first call your agency's Benefits Coordinator. If you need further information about eligibility for health coverage, call the State Health Benefit Plan at 404-656-6322 or 1-800-610-1863. For questions regarding other coverages, call the Flexible Benefits Program at 404-656-2730 or 1-888-968-0490.
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