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ADULT DISABLED DEPENDENTS

Retiree healthcare CARRIER REQUIREMENTS FOR ADULT DISABLED DEPENDENTS

It's important to understand the benefit plans LACERA offers—the differences between them can affect how you and any dependents qualify for and receive care. This page focuses on the process and requirements for enrolling and continuing coverage for an adult disabled dependent under the LACERA-administered Retiree Healthcare Benefits Program. As an active LACERA member, if you are currently covering an adult disabled dependent, you need to be aware of this information so you know how to continue this coverage into retirement without interruption.

Anthem Blue Cross
Eligibility Requirements The eligible dependent must have a qualifying diagnosis from a physician stating the dependent suffers from a disabling condition. The dependent must be unable to support himself/herself financially and must have at least six (6) months of creditable coverage as defined in the Evidence of Coverage booklet.
Required Records and Documents
  • Statement from the Subscriber that dependent is unable to support himself/herself financially and is reliant upon the Subscriber
  • Proof of six (6) months of creditable coverage
  • A Disabled Dependent Certification sheet completed by the Subscriber and the disabled dependent's physician within 31 days of the date the dependent first became eligible
CIGNA
Eligibility Requirements The eligible dependent must have a physician's statement that the disabling condition is debilitating and occurred before the dependent reached the limiting age 26.
Required Records and Documents

The following forms must be completed and returned to CIGNA Member Services:

  • Physician form for handicapped dependent
  • Questionnaire for Verification of Full-Time Student or Handicapped/Disabled Dependent Eligibility
Kaiser Permanente
Kaiser Permanente administers plans for LACERA retired members in six (6) different states: California, Colorado, Georgia, Hawaii, and Oregon. If you live in one of these states, you should contact your local Kaiser Permanente customer service representative for state-specific details. However, the following eligibility requirements and required documents apply to all six states.
Eligibility Requirements
  • The dependent is incapable of self-sustaining support due to a disability that occurred prior to reaching the limiting age of 26.
  • The dependent receives all of his/her substantial support and care from the Subscriber or the Subscriber's spouse/domestic partner
Required Records and Documents
  • Proof that the dependent meets the eligibility requirements described above
  • A completed Disabled Dependent Enrollment Application (Required for all states except Hawaii)
UnitedHealthcare (formerly PacifiCare)
Eligibility Requirements

The disabling condition must have occurred before the eligible dependent reached the limiting age of 26. The dependent must live in the United Healthcare service area with the Subscriber or the Subscriber's spouse/former spouse or domestic partner.

Proof of disability must be provided to United Healthcare within 31 days of one of the following:

  • The onset of the disability
  • The dependent reaching the limiting age
  • The Subscriber's initial enrollment in United Healthcare
Required Records and Documents
  • United Healthcare requires written documentation from the eligible dependent's treating physician or psychiatrist clearly identifying the approximate onset date of the disability
  • This documentation must provide a clinical determination that the disability exists and that the dependent is mentally or physically incapable of self-sustaining employment
  • Supporting documentation from a state or federal agency may also be helpful, but is not required
SCAN
Eligibility Requirements A dependent is eligible for coverage if he/she is at least 18 years old and is eligible for both Medicare A and B
Required Records and Documents

Once you submit proof of Medicare A and B eligibility there is no difference between enrolling a disabled or non-disabled dependent for coverage

Finally, if you are a new enrollee or applying for re-certification, there are some helpful tips you should know that apply to all the plans under the LACERA-administered Retiree Healthcare Benefits Program.

  • New Enrollment—Although you typically submit a written statement to enroll your eligible Adult Disabled Dependent, your insurance carrier may send a request for additional information. Please provide any requested information in a timely manner to ensure your dependent is covered.
  • Re-Certification—Once your dependent has been initially enrolled, your insurance carrier may periodically request updated information in order to re-certify eligibility for continued coverage. Providing requested information to your carrier in a timely manner will help you to avoid a lapse in coverage for your dependent.

If you have additional questions, please contact the carriers directly.

7/2/15