Life Events – Child Turns 26

Insurance Eligibility for Dependents
Effective January 1, 2011, the Patient Protection and Affordable Care Act allows your dependent children to continue eligibility for coverage up to age 26 regardless of their full-time student status.

Illness or Disability
Your child also remains eligible for coverage if incapable of self-sustaining employment because of mental handicap, mental illness, mental disorder or physical disability, and is chiefly dependent upon you for your support and maintenance. If your child is 26 years or older and unmarried at the time of your initial application for coverage, you must provide proof that your child meets these requirements within 30 days. Your child will then remain eligible for coverage as long as he/she continues to be handicapped and dependent.

End of Dependent Eligibility Status
If your child is 26 or older, your child is no longer eligible to be continued on your benefits coverage.

One coverage option for your child is under COBRA continuation provisions. Dependent children who are canceled from their parents’ plan can continue coverage by paying the full cost, plus any administrative fee.

To request COBRA instructions and application, contact the GaBreeze Benefits Call Center at 1-877-342-7339 within 60 days from the date your child loses eligibility. Even though you have 60 days to make the election, it is recommended that you elect COBRA continuation coverage early to avoid a disruption in your child’s coverage.

A qualifying event only allows you to add or delete a coverage level (i.e., You Only to You + Family, or You + Family to You Only coverage). A qualifying event does not allow you to change your type of coverage (i.e., PPO to United Healthcare or Prepaid Dental to Regular Dental). It is the employee’s responsibility to submit required documents within the time allowed (30 days). You are encouraged to contact GaBreeze as soon as possible. Your request for enrollment or a change outside of the enrollment period will only be considered if you submit the proper documentation within the time frame allotted.

To submit a request for enrollment or changes to coverage under the State Health Benefit Plan, you must submit a completed Membership or Discontinuation Form to your employer’s benefits coordinator within 30 days of a qualifying event (unless another time period is specified). Your request for enrollment or a change in any other coverage under the Flexible Benefits Program must be completed online at www.gabreeze.ga.gov or by contacting the GaBreeze Benefits Call Center at 1-877-342-7339 within 30 days of a qualifying event (unless another time period is specified). If you fail to submit required documents within the time period allowed, you will not be able to make changes until the next annual enrollment period.

Generally, any changes will go into effect the first of the month following the date when the payroll deduction is changed to reflect your new choice.

If you have questions regarding a change in any of your coverages, first call your agency’s benefits coordinator. If you need further information about eligibility for health coverage, call the State Health Benefit Plan at 404-656-6322 or 1-800-610-1863. For questions regarding your Flexible Benefit coverages, please call GaBreeze at 1-877-342-7339.

Other life events affecting your benefits: