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    DEPENDENT COVERAGE

    How long can my dependents remain covered under my plan?
    Eligible dependent children are covered until the end of the month he/she turns age 26. T
    hey will be offered continuation coverage through COBRA.

    Please Note:  It is fraudulent to continue coverage on a child who is no longer eligible under the plan's definition of eligible dependents.  
     

    My dependent child is 26 years old.  Can I keep them under my insurance plans?  Is there an additional cost? 

     

    Yes to both questions.  Lee County Benefits Plans allows medical coverage only for dependents from the age of 26 through the end of the year in which they turn 30. 

     

    The premium is equivalent to the total amount for single coverage which will be charged on a monthly basis.   NOTE:  This premium amount is in addition to any other medical premiums deducted from your paycheck.

     

      The following criteria must be met for dependents age 26 – 30 to remain on your plan:

    ·         Is unmarried and does not have a dependent of his or her own;

    ·         Is a resident of the state of Florida or a student; and

    ·         Is not eligible or provided coverage as a named subscriber, insured, enrollee, or covered person under any other group, blanket, or franchise health insurance policy or individual health benefits plan, or is not entitled to Social Security Benefits;

    Þ  A child that turns age 26 and is already a Lee County covered dependent will be required to meet the above criteria on the first of the month following their 26th birthday.   

     

    ·         If your child was not previously a covered dependent under your benefits plans, they must have been continuously covered by other creditable coverage without a gap in insurance of more than 63 days after the end of the month in which the dependent reached aged 26.  Proof of creditable coverage must be submitted at the time of enrollment.

    My child is no longer an eligible dependent. How can I remove him/her from my plan?
    You must complete and submit an Enrollment/Change form removing the child from coverage within 60 days of the date your child becomes ineligible.

    My child is going away to school. Can he/she still be covered under my plan?
    Yes, coverage can continue through the end of the month your child turns age 26.  He or she will still be able to remain enrolled in your chosen plan with you and/or the rest of the family. Depending on where your dependent resides while in school, his/her out-of-pocket expenses will vary.
    In-network: If he/she resides in an area with an open Aetna Select Open Access or Aetna Choice POS II plan, he/she will pay the same co-pays as if they were residing at home.
    Out-of-network: If they reside outside of an Aetna Select Open Access or Aetna Choice POS II network area, the coverage is 80/20 – the plan pays 80% and you pay 20% of reasonable and customary charges. Please let the Benefits Team know the address of your out-of-area dependent so that there will be no claims issues as a result of being out of the area.

    How do I find care for my son or daughter who goes to college outside of the area?
    To find care for out-of-area dependents, go to www.aetna.com and click on Find Health Care in DocFind.  If your dependent does not live in an open Aetna network area, he/she will pay 20% of usual and customary charges for the medical services he/she receives.

    What is an Affidavit of Eligibility Form? 
    This form provides documentation that the employee's dependent meets the plan criteria to remain on the Lee County Benefit Plans after the end of the month in which the dependent turned age 26.