This article is about Justworks PEO and Payroll. What product am I using?
NY DU30 Continuation (Aetna only)
Who is eligible for NY DU30 continuation?
For an overage dependent to be eligible, the parent(s) of the dependent must be actively covered under an eligible group health contract. Eligible dependents must be the insured's child (by blood or by law) and must meet the following criteria (as determined by your policy):
- Under the age of 30
- Unmarried
- No dependents
- Not covered as a named subscriber, enrollee or covered person under any other health plan including Medicare
- Lives, works, or resides in the service area of the insurer's network-based policy or contract
- Is a full or part-time student at an accredited institution of higher education
Length of continuation
The continuation will cease on the earliest of the following events (as determined byyour policy):
- The dependent's 30th birthday
- The dependent voluntarily terminates coverage
- The employee (insured) loses coverage
- The date the dependent becomes covered under another group plan
- The date the dependent marries
- The date the dependent moves out of state
- The date the dependent graduates
- The date on which due premium is not paid
- The date on which the group plan terminates or the date the employee's employer terminates participation under the group plan.
If coverage is replaced by another group policy, the employee and the dependent have the right to become covered under the new policy for the balance of their continuation period.
Disabled Dependents (All Carriers)
Dependents who are disabled or incapacitated may be eligible to continue coverage after 26. Each carrier has different requirements and enrollment processes.
If approved, the dependent is added to the employee’s current coverage in Justworks as a child dependent. Members' coverage tier and monthly premium cost may change with the addition of the overage incapacitated / disabled dependent.
The dependent will need to be added via open enrollment and paperwork would need to be submitted to the carriers for approval. The carriers will provide an approval window for coverage. You will have access to add the dependent via open enrollment during the approval window. You can request a form by emailing our support team.
Florida Dependents (Aetna only)
Typically, dependents are removed from coverage at the end of the month in which they turn 26. In accordance with FL legislation , members who qualify can keep their dependents on their insurance until 12/31 of the year the dependent turns 26. Members will have their 26 year old dependents automatically removed at the end of the calendar year
How do I add my Dependent?
Depending on the overage dependent coverage type, a supplemental enrollment form may need to be signed and returned to Justworks. You can request a form by emailing our support team. Justworks will then confirm the dependent is eligible for the extended coverage and forward the form to Aetna. Aetna will need to receive the enrollment form within 31 days of the qualifying event (i.e., the date the dependent would otherwise age off of the plan). Aetna will then set up a specific CSA for the overage dependent. The dependent will retain the plan that the employee/dependent is currently enrolled in.
During health insurance renewals, since Justworks will not automatically enroll your overage dependent on your plan for the new plan year; you will need to add your overage dependents on your plan for the new plan year. You must submit your final overage dependents by the end of the day on September 26. Otherwise you would need to wait for a QLE to add your overage dependents.
How much will this cost?
The premium charge for overage-dependent coverage may vary depending on your policy. If you have questions about premium we encourage you to reach out to Justworks at support@justworks.com or (888) 534-1711.
How does billing work?
Billing structure will depend on your policy and overage dependent coverage type. For dependents who are moving to a separate plan for their continued coverage, Aetna will bill overage dependents directly, and he/she will remit the premium directly to Aetna. Aetna's Individual Billing Administration (IBA) department will do the billing. Enrollees will be required to enter an address in the "Direct bill dependent" section on the supplemental enrollment form even when it is the same as the employee's address.
Disclaimer
This material has been prepared for informational purposes only, and is not intended to provide, and should not be relied on for, legal or tax advice. If you have any legal or tax questions regarding this content or related issues, then you should consult with your professional legal or tax advisor.