UT Benefits for Your Dependents – Eligibility and Documentation
Whether you have family members who are currently covered or you want to add coverage for someone in your family, it’s important for you to know the eligibility rules for the UT Benefits program. To comply with applicable laws and to help control overall costs, the UT System Office of Employee Benefits (OEB) and your institution Human Resource and Benefits offices must ensure that everyone who participates in the UT Benefits program as a dependent is eligible to do so. If you cover your spouse or children through the UT Benefits program, you should also be prepared to provide required documentation verifying that your dependents are eligible to participate.
Eligibility to participate in certain UT Benefits coverage as a dependent is determined by law. Because of changes made by the federal Affordable Care Act (ACA), your children (including stepchildren and adopted children) are eligible for the UT SELECT Medical plan, regardless of marital status, until they reach the age of 26. Eligibility of dependents who do not qualify as your spouse or child (such as eligible grandchildren), ends at age 25 for all UT Benefits coverage, including the UT SELECT Medical plan. Eligible dependents are:
- Your spouse, as defined by Texas Family Code;
- Your children, including stepchildren and adopted children, who are:
- under age 26 regardless of marital status for the UT SELECT Medical plan,
- unmarried and under age 25 for other UT Benefits (Dental, Vision, Life, AD&D);
- Your unmarried grandchild(ren) under age 25, provided the child qualifies and is claimed as your dependent for federal tax purposes;
- Certain children over age 25 (over age 26 for the UT SELECT Medical plan), who are determined by OEB to be medically incapacitated and are unable to provide their own support; and
- Children for whom you are named a legal guardian or who are the subject of a medical support order requiring such coverage.
Eligibility for dependents that you wish to enroll in UT Benefits must be established by providing appropriate supporting documentation. When requesting to add a dependent to your plan, you should be prepared to provide copies of relevant documents which may include items such as your marriage certificate, your child(ren)’s birth certificate(s), completed adoption paperwork, or other legal documents. Look for additional details in an upcoming newsletter about an enhancement to the My UT Benefits online system that will allow you to conveniently handle this requirement electronically when adding coverage for your eligible dependents during Annual Enrollment.
Misrepresentation of dependent eligibility constitutes a policy violation that could result in consequences ranging from a reprimand to dismissal and may also require that you reimburse benefits paid on behalf of an ineligible individual. Deliberate misrepresentation may constitute criminal fraud and could result in a referral to law enforcement.
The upcoming Annual Enrollment period provides an excellent opportunity to review your dependent coverage. It’s especially important to verify that each of the individuals you cover as a dependent under any of your UT Benefits insurance plans still meets the definition of an eligible dependent. For those who no longer qualify, you should cancel the coverage using My UT Benefits or by contacting your local Human Resources or Benefits Office for assistance.