Student Status Documentation

This chart provides information on the documentation needed to add a dependent on to a health contract or re-enrollment of a dependent that was at one time ineligible.

  • Initial Enrollment
  • Re-enrolling a dependent
Enrollment Situation Situation & Resolution Coverage Effective

1. Enrolling Dependent at time of Initial Enrollment

A dependent can be included on your "initial" enrollment Health Insurance Application/Change form. No special documentation is needed.

Coverage is effective on the same date as the effective date for the subscriber.

2.  Re-enrolling Dependent on contract if dependent was once ineligible
Family coverage in force

If a dependent was no longer eligible because they were not a full-time student and later the dependent again becomes a full-time student before age 25, that dependent can be added back onto a "family" contract by doing the following:
Submit a Health Insurance Application/Change form (ET-2301) indicating the name of the dependent being added
If the application is not filed timely, additional documentation is required.  Submit one of the following with the application:

  • a letter from the Educational Institution indicating the status for current semester; or
  • a copy of the dependent’s current class schedule; or
  • a copy of the payment receipt from the Educational Institution indicating payment of tuition for the current semester; or
  • a copy of the Dependent Verification Form that was submitted to the health plan.

On the event date which is the date the dependent returned to full-time student status.

If the application is NOT timely, if adding the dependent is approved, coverage will be retroactive to the first of the contract year.

3.  Re-enrolling Dependent on contract if dependent was once ineligible.
Single coverage in force

If a dependent was no longer an eligible dependent, the subscriber has single coverage in force and wants to re-enroll that dependent, if done timely, the following is required:
A Health Insurance Application/Change form (ET-2301) changing from "single" to "family" coverage and indicating the name of the dependent being added.
If the application is not filed timely, additional documentation is required.  See above Item 2 for acceptable documentation.

On the event date which is the date the dependent returned to full-time student status.
If application is NOT timely, see Item 2 above for coverage effective date.