BN - Adult Child Disability Process

GENERAL DESCRIPTION:

This document outlines the process for requesting the review of the disabled status for an adult child by the health provider. If disability status is approved, the adult dependent may be added to the employee’s state group health, dental and/or vision benefit plans.

PROCESS CONSIDERATIONS:

Overview of the Adult Child Disability Process:

Once an employee’s adult child is no longer considered their dependent for benefit purposes, the child is removed from the employee’s health, dental and vision benefit plans at the end of the month they turn age 26.

The employee may request review of the disabled status by the health provider to determine if the adult child qualifies as having a disability of long standing duration, are unmarried, dependent on the employee or the other parent for at least 50% of support and maintenance and are incapable of self-support.

The application must be submitted within 30 days of the health provider's approval.  Preferred process will have the employee submitting the application(s) requesting the adult child to be reinstated based on disability approval.  The submission of the applications will start the disability approval process with the health provider. Do not make enrollment entry into HRS at this time. Upon receipt of approval from the health provider, the applications will be entered into HRS.

If the employee worked directly with the health provider and received approval before submitting the application, simply have the employee provide you a copy of the approval letter from the health provider with the applications and enter in HRS based on the effective date of the approval.

Per Chapter 5 of the State Agency Health Insurance Administration Manual, the disabled dependent’s (child age 26 or older) coverage is effective the date the health plan approves the dependent’s disabled status. The employee submits an application which ETF forwards to the health plan to have them complete their disability review process. When the health plan has reviewed the adult child’s disability status, ETF will update the coverage accordingly. Documentation to support the disability is required as outlined in the Group Health Insurance Application/Change Form.

You may click on the links below to navigate directly to a section:


Process Flow
The below link provides a visual workflow for the Adult Child Eligibility through Disability process.

DisabilityAge26ProcessMap.pdf


Actions Required by UWSC – Benefits Team:

Note* UW-Madison will create their own ticket and complete process. 


Actions Required by Institution Benefit Administrator:

NOTE:  If the employee is wanting to enroll the adult child (over age 26) as disabled in only the dental and/or vision plans, there will be no review by the health provider.  We are allowing the employee to self- identify that adult child as disabled.  They employee will need to provide a letter signed by the medical provider.  The letter should indicate that the unmarried adult child is incapable of self-support because of mental or physical disability that can be expected to be of long-continued or indefinite duration of at least one year.   This letter should be included with the applications.  The adult child must still meet the requirement of being dependent on the employee or the other parent for at least 50% of support and maintenance and incapable of self- support. Please keep in mind if there is no health provider review, the adult child may not be added to the employee's health plan.

Update Dependent
health Benefit



ADDITIONAL RESOURCES

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