|page: 1 2 3|
If your child has one of the following disabilities noted in the medical certificate, and the disability began before age 22, your employing office or health benefits carrier can automatically extend continued coverage.
This list doesn't include all the disabilities that would cause a child to be incapable of self support.
Your child's doctor must complete a medical certificate for the employing office to make its determination of incapacity of self-support. The certificate must state that your child is incapable of self-support because of a physical or mental disability that existed before he/she became age 22 and that can be expected to continue for more than one year. In addition, the certificate must include the following information:
You may submit the medical certificate to your employing office when you first enroll or at any time in which your child is covered under your self and family enrollment, but no later than 60 days before your child reaches age 22.
If your employing office determines that your child is incapable of self-support, your employing office must notify the carrier of your plan by letter, before your child reaches age 22. The letter must identify you by name and social security number, and state the name and date of birth of your disabled child as well as the duration of the approval. It will send the letter to the carrier with a regular transmittal report. It will not send the medical evidence used in its determination to the carrier, but will attach it to your most recent Health Benefit Election form (SF 2809) or other enrollment request in your Official Personnel Folder.
If you have a new enrollment, your employing office will note its determination of incapacity of self-support in the Remarks section of your SF 2809.
In making its medical determinations, your employing office must use a physician's services if available, unless your child's condition is one for which it can automatically extend continued coverage. In doubtful cases, or if no physician is available, your employing office may request assistance from: Office of Personnel Management, Retirement and Insurance Service, Office of Insurance Programs, P.O. Box 436, Washington, D.C. 20044.
Depending on your child's medical certificate, your employing office may approve coverage due to disability for a limited period of time (1 year, for example), or without time limitation (permanent). Your employing office must also confirm that your child meets the financial dependency requirement.
If your employing office approves your child's medical certificate for a limited period of time, it must remind you, at least 60 days before the date the certificate expires, to submit either a new certificate or a statement that the certificate will not be renewed. If it is renewed, your employing office must notify the carrier of your plan of the new expiration date by letter.
If you don't renew a medical certificate for a disabled child age 22 or over, your child's status as a family member automatically ends and he/she is no longer covered. Your employing office must notify you and the carrier of your plan that your child is no longer covered.
If you submit a medical certificate for a child after a previous certificate has expired, or after your child reaches age 22, your employing office must determine whether the disability existed before age 22. If your employing office determines that it did, and you continuously had a self and family enrollment, your child is considered to have been a covered family member continuously since age 22.