| PEBB Definition of a Dependent Child |
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| "Dependent Child" |
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Following is the text of the definition of "Dependent Child," from OAR 101-010-0005 Definitions
Dependent Child
(1) In defining dependent child eligibility, PEBB uses the Internal Revenue Code (IRC) 152 as revised by the Working Families Tax Relief Act of 2004. A dependent child must meet the following PEBB eligibility requirements:
(a) The child is an eligible employee’s, spouse’s, or domestic partner’s:
(A) Biological, adopted, or a placed for adoption child; or
(B) Child by Affidavit. A Child by Affidavit includes, but is not limited to, a foster child, a ward of the court, a child under legal guardianship, or the child of a dependent. The child must meet PEBB eligibility requirements. The eligible employee must complete and return to the agency a notarized PEBB Affidavit of Dependency form within five business days of the child’s electronic enrollment date or the date the agency receives the enrollment forms. PEBB terminates the child’s coverage retroactive to the effective date if the notarized affidavit is not received within the specified time.
(b) The dependent child is not married, does not have a domestic partner, is not in the military and is a member of the eligible employee’s household.
(c) Regarding age, the dependent child is:
(A) Under the age of 19 at the end of the calendar plan year.
(B) Between the ages of 19 and up to age 24 during the plan year, and is a full time student who has not attained the age of 24.
(i) Student means an individual who during each of five calendar months during the calendar year is a full-time student at an education organization that normally maintains a regular faculty and curriculum and normally has a regularly enrolled body of students in attendance at the place where its educational activities are regularly carried on.
(ii) To be full-time, the student must be enrolled for the number of hours or courses the school considers full-time attendance. The term school includes elementary schools, junior and senior high schools, colleges, universities, and technical, trade, and mechanical schools. It does not include on-the-job training courses, correspondence schools, or schools offering courses only through the internet. People who work “co-op” jobs in private industry as part of a school’s regular course of classroom and practical training are full-time students.
(iii) Beginning in 2010, seriously ill or injured full time student dependents covered under an eligible employee’s plan immediately before the first day of a medically necessary leave of absence, or change in enrollment such as full-time to part-time, may continue coverage for up to one year while on a medically necessary leave of absence. “Medically necessary leave of absence” means a leave of absence from a post-secondary educational institution, or any other change in enrollment at the institution that starts while the child is suffering from a serious illness or injury, is medically necessary, and causes the child to lose student status for purposes of PEBB eligibility. A physician of the dependent must provide a written certification to PEBB stating that the child is suffering from a serious illness or injury and that the leave of absence (or change in enrollment) is medically necessary. The extension of coverage continues until the earlier of one year after the first day of the leave or the date that coverage would otherwise terminate, (e.g., due to an age limitation).
(C) Between the ages of 19 and up to age 24, lives in the eligible employee’s household over six months of the calendar year, and the eligible employee provides over half the child’s yearly support.
(d) There is no age limit for a dependent child who is incapable of self-sustaining employment because of a developmental disability, mental illness, or physical disability.
(A) The attending physician must submit documentation of the disability to the eligible employee’s PEBB medical insurance plan for eligibility approval. Once approved, the medical plan may
review the dependent’s health status at any time to determine the child’s continued PEBB eligibility.
(B) When the dependent child is 24 years of age or older, the disability must have existed before attaining age 24.The child must have had continuous medical insurance coverage, group or individual, prior to attaining age 24 and the insurance must continue until the PEBB insurance effective date.
(C) If the child terminates from PEBB insurance coverage after age 24, the child is ineligible for future enrollment as a dependent child under PEBB coverage.
(e) The child must be a U.S. citizen, national or resident of the U.S. or a resident of Canada or Mexico. When an adopted child or child placed for adoption fails this requirement, they can still be the employees’ dependent child if the child has the employee’s home as his principal home and is a member of the employees’ household, and the employee is a citizen or national of the U.S. Foreign students are not eligible for PEBB coverage.
(f) The child must not qualify as any other person’s dependent child, except that a child of divorced or separated parents meeting conditions under IRC 152(e) can be treated as dependent of both parents for the purpose of health insurance coverage.
(2) Eligible employees who want to provide insurance coverage to dependent children that will be between the ages of 19 and up to age 24 must certify during the open enrollment period the dependent’s continued eligibility for the following plan year. Dependents not certified during open enrollment will lose coverage the last day of the current plan year. The yearly dependent certification excludes children approved by the insurance plan as incapable of self-sustaining employment because of a developmental disability, mental illness, or physical disability.
(3) PEBB terminates all insurance coverage for dependent children the last day of the month in which the child reaches age 24. PEBB will not terminate coverage for children age 24 or older when approved by the insurance plan as incapable of self-sustaining employment because of a developmental disability, mental illness, or physical disability.
Stat. Auth.: ORS 243.125
Stats. Implemented: ORS 183, 192 & 243
Hist.: PEBB 3-2009, f. 9-29-09 cert. ef. 10-1-09
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