Adult Incapacitated Dependents Special Enrollment
From: Human Resources
Please see the following message from Virginia Department of Human Resource Management.
The State Health Benefits Program (the Program) covers eligible adult dependents until the end of the year in which they turn age 26 (the plans limiting age). The Program allows adult dependents who are incapacitated to remain covered if they meet certain eligibility criteria.
Effective July 1, 2023, Section 2.2-2818 of the Code of Virginia revises the adult incapacitated dependent (AID) requirements for continued coverage as an AID due to a physical or behavioral health condition. The residency requirement that the AID must only reside full-time with the employee and/or other natural/adoptive parent as a member of the employee’s household; has expanded to allow the AID to be “receiving residential support services” which means the AID can be living in a group home, nursing home/convalescent home, long-term care facility or similar facility that provides services for physically and/or mentally disabled.
To comply with the new AID criteria, the Program will allow a one-time (60-day) Special Enrollment Period from Saturday, July 1, 2023 through Tuesday, Aug. 29, 2023 for any eligible AID to be enrolled if they meet the new expanded residency criteria (in addition to meeting the other eligibility and medical criteria). To be considered for this one-time Special Enrollment, of your eligible adult dependent as an AID, you must do the following:
- Complete and return the AID Eligibility Verification form and the State Health Benefits Enrollment form for Active Employees between Saturday, July 1 – Tuesday, Aug. 29.
- Contact your applicable health plan directly (beginning July 1) to request the necessary paperwork to begin the medical review process for the adult dependent.
This one-time Special Enrollment will be a prospective election and, if approved, will be effective the first of the month following receipt of the completed forms. You have an additional 60 days from your submission date to submit all required supporting documentation to the Office of Health Benefits (OHB).
If the enrollment request is not received by Tuesday, Aug. 29, 2023, you will have missed the opportunity for this Special Enrollment election to enroll your AID. This means that you will not be able to request a review for your AID unless there is another consistent qualifying life event that would allow such a change.
Keep in mind, that this one-time Special Enrollment is only an eligibility review; your health plan will still need to review, to determine if your adult dependent meets the medical criteria as an incapacitated dependent. Therefore, any required medical documentation to determine incapacitation must be submitted to your enrolled health plan. It is your responsibility to contact Member Services for your applicable health plan at the phone number listed on your health insurance card.
Note: This Special Enrollment does not apply to adult dependents currently enrolled in a health plan under the Program that reaches the plan’s limiting age this year. These adult dependents will still lose health coverage on Dec. 31, 2023, and the normal process for handling AIDs will continue to be adhered to, and those impacted employees will be notified and receive guidance from their benefits administrator in the fall 2023.
Also, if you currently have an approved AID on your health plan, there is no action required during this Special Enrollment.
Please visit https://www.hr.vt.edu/benefits/health-insurance/health-plans.html for additional enrollment information.