| Adult Child Eligibility |
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Children age 19 to 24 may remain eligible for PEBB benefits if they meet the criteria stated below.
As a PEBB member, you are responsible to notify PEBB when a dependent is no longer eligible for benefits. It’s true that busy people can overlook eligibility issues. But if you do forget, you could find yourself in the position of having to repay claims paid when your child was not eligible.
To help members remember each year, PEBB will send a letter to members who have children age19 to 24. The letter will ask them to notify PEBB if the child will not meet the criteria on his or her next birthday. Members can expect the letter about 60 days before the child’s birthday. This 60-day window will allow ineligible children to obtain other coverage, such as COBRA.
What should you do if you receive the reminder letter?
- If your child will continue to meet the criteria on the next birthday, you won’t have to contact PEBB or make any changes in your benefits; coverage will continue.
- If your dependent will not meet the criteria on the next birthday, submit a medical and dental update form to have the dependent removed from coverage. Your dependent’s coverage will end on the last day of the month your dependent no longer meets the criteria.
When your child turns 24, all benefits terminate the last day of the birthday month. Contact your medical carrier or PEBB for more information.
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| Dependent Child Criteria |
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Following is a summary of PEBB’s definition of “dependent child.”
A dependent child must be either:
- A biological or adopted child, or a child placed for adoption with the employee or the employee’s spouse or domestic partner; or
- A legal ward by court decree; a dependent by Affidavit of Dependency; or under the legal guardianship of the employee, or the employee’s spouse or domestic partner.
The child:
- May not be married or have a domestic partner
- May not qualify as a dependent under IRS rules for anyone other than the eligible member
- May be treated as a dependent for the purpose of obtaining healthcare coverage by both parents who are divorced or legally separated.
A dependent child must also meet one of the following criteria. The child:
- Is under the age of 19 at the end of the calendar year; or
- Is age 19 to 24 and meets the IRS definition of a dependent child attending school full time (which excludes foreign students); or
- Is age 19 to 24 and the eligible member provides or expects to provide more than half the child's support for the year, and the child lives in the eligible member's home for at least six months of the year; or
- Is age 19 to 24 and is incapable of self-sustaining employment because of a developmental disability, mental illness or physical disability; or
- Is age 24 or older and is incapable of self-sustaining employment because of a developmental disability, mental illness or physical disability that existed before the child attained age 24. The child must have had continuous individual or goup medical coverage prior to attaining age 24 and until the PEBB effective coverage date.
If you are in doubt if a person in your family qualifies as a dependent child, contact your agency or PEBB. Retiree, COBRA and other self-pay participants, contact PEBB’s third-party administrator, BenefitHelp Solutions.
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