The LACERA-administered healthcare benefits program recognizes disabled adult children of LACERA members, or their spouse or eligible domestic partner, as eligible dependents, provided the disabled adult child meets all of the following requirements:
- Is incapable of self-support due to a physical or mental handicap
- Became disabled before age 26
- Is fully dependent on the LACERA member or the member’s spouse or eligible domestic partner for financial support
- Has been continuously covered by a County-sponsored plan and/or proof is provided that the disabled child meets the other requirements above and has been continuously covered by any other group or individual medical insurance plan
- Provides medical evidence of total disability, subject to the conditions of both LACERA and your LACERA-administered healthcare plan
Enrollment and continuation of coverage requirements vary according to the LACERA-administered healthcare plan carrier. For a complete listing of each carrier's eligibility requirements and required documentation, see the table below, or contact Retiree Healthcare.
Retiree Healthcare Carrier Requirements for Adult Disabled Dependents
The differences among benefits plans can affect how you and any dependents qualify for and receive care. See the table below for the process and requirements for enrolling and continuing coverage for an adult disabled dependent under the LACERA-administered Retiree Healthcare Benefits Program. If you are an active LACERA member currently covering an adult disabled dependent, you need to know this information so you can continue this coverage (provided all requirements are met and all documentations have been received) 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 months of creditable coverage
- • A Disabled Dependent Certification form completed by the subscriber and the disabled dependent's physician must be submitted within 31 days of the date the dependent first became eligible. The form needs to be received within 30 days for a new enrollment.
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
- • Documents must be submitted no later than 31 days after the date the child ceases coverage at age 26.
Completed forms can be faxed to 860-517-3009 or mailed to:
Cigna HealthCare
P.O. Box 692012
San Antonio, TX 78269
Kaiser Permanente
Kaiser Permanente administers plans for LACERA retired members in six 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)
United Healthcare
- 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. Medical documentation must be dated within the last three months.
- • 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 Part A and Part B.
- Required Records and Documents
- Once you submit proof of Medicare Part A and Part B eligibility, there is no difference between enrolling a disabled or non-disabled dependent for coverage.
Requests for Additional Information
- 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. Be sure to provide any requested information in a timely manner to ensure your dependent is covered.
- Re-certification: Once your dependent has been enrolled, your insurance carrier may periodically request updated information in order to re-certify eligibility for continued coverage. Be sure to provide any requested information in a timely manner to avoid a lapse in coverage for your dependent.
If you have more questions about enrolling an adult dependent in your plan, contact your insurance carrier directly.