Dependent Eligibility and Documentation Requirements
Understanding Dependent Eligibility and Documentation Requirements
With Annual Enrollment this month, it’s important to be aware of the dependent eligibility rules for the UT Benefits program and the requirement to provide documentation verifying that your dependents are eligible to participate. Here is a brief review of the dependent eligibility requirements as well as information about providing required supporting documentation.
Eligibility to participate in certain UT Benefits coverage as a dependent is determined by law. Eligible dependents are:
Enrolled children may remain eligible for UT Benefits as an incapacitated dependent if they are determined to be medically incapacitated at the time they age out of eligibility for coverage as a child under the program (either at age 25 or 26, depending on coverage type). An older dependent child who is determined to be medically incapacitated at the time a subscriber first becomes benefits eligible may be enrolled in the plan if the child was covered by the subscriber’s previous health plan with no break in coverage. Please contact your institution's Human Resources or Benefits Office for additional information about covering incapacitated dependent children.
Misrepresentation of dependent eligibility constitutes a policy violation that could result in consequences ranging from a reprimand to dismissal. Misrepresentation 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 institution's Human Resources or Benefits Office for assistance.