The enrollee's dependent child is eligible for coverage at any age provided the dependent is permanently mentally or physically disabled, so incapacitated as to be incapable of self-sustaining employment, and depends upon the enrollee for 50 percent or more support. The disabling condition must have occurred before the dependent's 26th birthday. The enrollee must provide written proof of the incapacity including documentation from a provider. Neither a reduction in work capacity nor an inability to find employment is, of itself, evidence of incapacitation. Coverage may continue for as long as the incapacitation exists and the enrollee remains covered under the Plan.
Proof of disability must be provided to BCBSMS 31 days before the date a child would cease to be covered because of age. The Plan reserves the right to request proof of continuous disability.
New employees who wish to enroll a permanently disabled dependent over age 26 must submit a Request for Coverage for a Mentally or Physically Disabled Dependent form along with the Application for Coverage form. This form can be obtained from BCBSMS, who will make final determination of disability. The disabling condition must have occurred before the dependent's 26th birthday.
This article explains the eligibility criteria and enrollment process for covering permanently disabled dependents who are incapable of self-sustaining employment and rely on the enrollee for support.