Solid Group Plans Made Simple
Overage Dependent Coverage
Another summer is almost over. School will be starting soon. So it’s a great time to remind clients of the principles that guide group insurance eligibility for older dependent children.
Definition of dependent child
A dependent child is eligible for benefits coverage – extended health and dental, as well as dependent life insurance – under a group insurance plan. The maximum age is typically age 21 (as set out in the plan policy), but if the dependent child is a student, attending an educational institution full-time, they are eligible for benefits continuation to age 25, and age 26 in Quebec.
Student status verification
Does Johnstone’s Benefits provide third party administration services for your organization? If so, early in September, we will send you form letters to distribute to your affected employees. Declaration of student status, including the name of the educational institution that the student is attending, must be received by our office no later than September 30, 2022 for continuation of coverage. Otherwise benefits for the overage dependent will terminate.
Studying in another province/territory or country?
Group extended health plans typically include provisions for out-of-province and out-of-country medical emergencies during temporary absences while travelling due to business or pleasure. The overall maximum is specific to each plan policy, and depending on the amount, it may mean the insured has adequate coverage without purchasing additional travel insurance.
Most insurers will consider extended coverage for a dependent child who is studying in another province, territory or country. Some insurers may apply an additional premium. However, the insurer may not consider the absence as “travel” for purposes of coverage. Rather they may consider the student to be taking residence in another location. This can complicate their benefits coverage – so it’s important to be sure of their continued eligibility. We are here to help!
Provincial health coverage
To be eligible for continuation of extended health and dental, the student must maintain their provincial health insurance. Each province/territory has specific guidelines for students to continue provincial health, including for those studying outside of their normal province/territory of residence.
Common to other provinces/territories, if the student is normally a resident of British Columbia, and leaves BC temporarily to attend school in a recognized educational institution, they can retain their eligibility for provincial health insurance, with the following conditions:
- The student is a Canadian citizen, or a person lawfully admitted to Canada for permanent residence
- The student makes his or her home in British Columbia
- The student has been physically present in Canada for six of the 12 months immediately preceding departure
- The student will be in full-time attendance at an educational facility recognized by the Medical Services Commission
Once the student has completed his or her studies, they must return to BC by the last day of the month following the month in which their studies were completed. Otherwise, they will be required to fulfill a specified wait period upon their return to BC.
Coverage for a disabled dependent child
A dependent child between the age of 21 and 26 with a mental or physical disability may also be eligible for continuation of benefits if they are unable to earn a living because of the disability. The disability must be declared when the insured is an eligible dependent child.
Overage dependents not eligible for continued coverage
If the dependent child is no longer eligible for continuation of extended health and dental, many insurers offer a month-to-month extended health and dental plan. This information can be found on the insurer’s website, or by contacting us.
A reminder! Claiming rules for a dependent child.
When both spouses have employer sponsored benefit plans, the payment order for dependent children follow the “birthday rule”. Claims should be submitted first to the plan of the parent whose month and day of birth is earlier in the calendar year, and then to the other parent’s plan if there is an outstanding balance.