Dependent Eligibility and Documentation Requirements

Understanding Dependent Eligibility and Documentation Requirements

Image Description HereWith 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

Eligibility to participate in certain UT Benefits coverage as a dependent is determined by law. 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 (due to federal eligibility rules),
    • unmarried and under age 25 for other UT Benefits (Dental, Vision, Life);
  • Children for whom you are named a legal guardian or who are the subject of a medical support order requiring such coverage;
  • Your unmarried grandchildren under age 25, provided they qualify and you claim them as your dependent for federal tax purposes; and,
  • Certain children over age 25 (over age 26 for the UT SELECT Medical plan based on federal eligibility rules) who are determined by OEB to be medically incapacitated and are unable to provide their own support.

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.

Documentation - Evidence of Eligibility (EOE)

Image Description HereWhen requesting to add a dependent to your UT Benefits coverage, you must provide appropriate supporting documentation as Evidence of Eligibility (EOE). You should be prepared to provide copies of relevant documents. Depending on the relationship and circumstances, appropriate documentation may include items such as a marriage certificate, a birth certificate, completed adoption paperwork, or other legal documents.

The My UT Benefits online system offers the convenience of submitting documents electronically when adding NEW dependents to your benefits coverage during Annual Enrollment. To do this, you simply upload clear, legible digital images (scanned documents or photographs) of required documents directly through My UT Benefits as evidence of your dependent’s eligibility. Additional information will be available when you log into My UT Benefits, including FAQs about the documentation upload process. There is a separate tab for dependent information to help you more easily find details that you may need.

Important

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.