What happens when my child becomes over-aged based on the definition of a dependent child?

An over-age dependent child is eligible for benefits to the maximum age allowed in your district’s plan, provided they are a natural, adopted or step-child who is single (i.e. unmarried and not living in a common-law relationship) and financially dependent on you or your spouse. The overage dependent child must also be either in full-time attendance at a recognized school, college or university or be considered disabled. Full time attendance at school typically means more than ten hours of classroom instruction per week or to be registered in at least 3 classes per semester.

Pacific Blue Cross (PBC) will continue coverage as follows unless otherwise ineligible:

• When the dependent child reaches the minimum age of termination unless they are a student (i.e. Age 21 – may vary depending on your district’s plan) or functionally impaired – coverage ends at the end of the month of the dependent child’s birthday.
• When the dependent child reaches each birthday after previously qualifying for student status (i.e. age 22 to 24 – may vary depending on your district’s plan) – coverage ends at the end of the month of the dependent child’s birthday if not in school and/or no longer eligible.
• When the dependent child reaches the maximum age after previously qualifying for student status (i.e. age 25 – may vary depending on your district’s plan) – coverage ends at the end of the month of the dependent child’s birthday.
• If your over-age dependent child is disabled, PBC must approve continuation of coverage once your child has reached the minimum age, as specified in the My Benefits section of this website, for extended health and dental. To obtain approval, please complete the PEBT Change Form and provide a copy of the approved CRA or Persons with Disability (PwD) document to your School District Benefits Administrator. The School District Benefits administrator will submit the change form and the necessary documentation to the benefit provider. The provider will confirm in writing back to the School District Benefits Administrator whether coverage has been approved or declined. Your School District Benefits Administrator will contact you once confirmation has been received.

If your dependent child is considered an overage dependent, the following steps will be taken:

• The School District Benefits Administrator will provide you with the Over Age Dependent Form if the dependent child is nearing the maximum age (i.e. age 21), and for ages 22 to maximum age for annual re-certification.
• You must complete the Over Age Dependent Form if the dependent child is a student as defined above and return to the School District Benefits Administrator.
• You must return the completed form to the School District Benefits Administrator by the date shown on the form; otherwise, the dependent child will be removed from coverage at the end of the month the dependent child reaches the maximum age.