| 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
(8) "Dependent child" means any child who meets the criteria in this section. In defining dependent child, PEBB follows Internal Revenue Code (IRC) 152 as revised by the Working Families Tax Relief Act of 2004:
(a) The child must be a US citizen, national or resident of the US 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 US.
(b) The child is not married and does not have a domestic partner; and
(A) Is under the age of 19 at the end of the calendar year; or
(B) Meets the IRC 152(f)(2) definition of a dependent child between the ages of 19 and up to age 24 attending school full time, excluding foreign students; or
(C) Is between the ages of 19 and up to age 24, living in the home of the eligible employee over six months of the calendar year, and the eligible employee provides over half the yearly support; or
(D) Is between the ages of 19 and up to age 24, and is incapable of self-sustaining employment because of a developmental disability, mental illness, or physical disability. The attending physician must submit documentation of the disability to the insurance plan for approval. Once certified, the insurance plan may review dependent certification to determine continued eligibility; or
(E) Is a child age 24 or older, and is incapable of self-sustaining employment because of a developmental disability, mental illness, or physical disability. Except in the case of a child who previously qualified under (a) (D) of this section, the attending physician must submit documentation of the disability to the insurance plan for approval. The insurance plan may review dependent certification to determine continued eligibility. If the child is terminated from PEBB insurance coverage after age 24 for any reason, the eligible employee cannot re-enroll the child. A disabled dependent child, age 24 or older, must also meet the following criteria:
(i) The disability must have existed prior to attaining age 24.
(ii) The child must have had continuous medical insurance coverage, group or individual, prior to attaining age 24 and until the time of the PEBB insurance effective date.
(c) 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 a dependent of both parents.
(d) A dependent child must also meet one of the following criteria:
(A) Is a biological child of, an adopted child of, or a child placed for adoption with the eligible employee, spouse, or domestic partner; or
(B) Is a legal ward by court decree, a dependent by Affidavit of Dependency, or is under legal guardianship of the eligible employee, spouse or domestic partner, and is living in the home of the eligible employee.
(d) As referenced in OAR 101-015-0025(1) and (2) (h) a child of a domestic partner meeting the definition of a dependent child is eligible to receive insurance coverage subject to imputed value tax.
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