Age limits for dependent children
A dependent child is eligible for coverage until his or her 26th birthday or for two years after the end of the calendar year in which such child last qualified as a dependent under 26 U.S.C. 106, whichever occurs first. Coverage under the family or adult/child(ren) contract ends on midnight of the day before his or her 26th birthday. Whenever a dependent child’s coverage under the family coverage ends, the coverage for any offspring of that dependent child also ends.
Disabled dependents
A dependent child who is mentally or physically disabled when he or she reaches age 26, and is not capable of earning his or her own living, can remain on the family or adult/child(ren) contract. The subscriber must apply within 30 days of the child’s 26th birthday. The plan determines eligibility for disabled children. The subscriber must give any medical or other information that we may need to determine if the child is eligible to continue coverage
Certifying dependent status
When a dependent child reaches age 20, we will send a letter and form to the member requesting the dependent’s status. If the dependent is still a dependent based on IRS guidelines (or has been within the last two years), the subscriber should sign the form and return it to us by the date specified on the form.
The subscriber is responsible for notifying us of a dependent’s changes in status.
We will send a recertification form at the beginning of each calendar year. If you return the form stating that the dependent is no longer a dependent based on IRS guidelines (and has not been within the last two years), dependent coverage will end. If the form is not returned by the date specified on the form, we will assume that the dependent is no longer eligible for coverage and coverage will end effective April 1. In all of these cases, we will send a letter of termination of coverage to the subscriber.
Continuing coverage for former dependents
A dependent child who is no longer eligible for coverage may be eligible for continuation of coverage or conversion to a consumer plan.
Surviving dependents
A dependent’s coverage ends if the subscriber dies. The dependent may be eligible for continuation of coverage or conversion to a consumer plan.
Out-of-area student coverage**
Students attending school outside the service area are covered for a limited number of services while out-of-area, if authorized in advance by the plan. You must work with your PCP to get plan authorization.
These services include:
- Nonroutine medical office visits
- Diagnostic lab and X-ray connected with a nonroutine office visit
- Nonelective inpatient services
- Outpatient services to diagnose and/or treat mental conditions
- Speech therapy
- Short-term rehabilitation services, including physical and occupational therapy are covered for up to 60 visits combined in each calendar year (combined with any in-area visits).
Aside from emergency care, the services listed above are the only services that are covered for students on an out-of- network basis. To be covered, all other services must be obtained when they return to the service area.
Services that are not covered for students while out of the service area include:
- Routine physical, gynecological exams, vision screening and hearing screening
- Routine preventive care
- Nonemergency prescription medication. Students may use the prescription medication mail-order program to fill medication refills.
- Second opinion
- Preventive dental care or minor restorative care (e.g., fillings)
- Chiropractic care services
- Home health care
- Outpatient surgical procedures that could be delayed until return to the FCHP service area
- Maternity care or delivery
- Durable medical equipment (e.g., wheelchairs), including maintenance or replacement
* Benefits and coverage may vary by product, plan design and employer. For specific details regarding your FCHP plan, benefits and features, please check with your employer or contact a member of our customer service team at 1-800-868-5200 (TDD/TTY: 1-877-608-7677), Monday through Friday, 8 a.m. to 6 p.m. Eastern time. MassHealth members can call the MassHealth Customer Service Center at: 1-800-841-2900 (TDD/TTY: 1-800-497-4648) Monday through Friday, 8 a.m. to 5 p.m.
** This section doesn't apply to Fallon Preferred Care PPO plan members.