Dependent Coverage
Q: My spouse is on an employer’s plan, but we are realizing the C&MA Plan is better. Can I enroll my spouse whenever I want?
Unfortunately, the plan does not allow you to enroll your spouse whenever you want. However, you can only enroll your spouse at certain times such as Open Enrollment, or within 30 days of a qualifying event. For example, if the other job ends, or the other plan has a significant rate increase, those would be qualifying events.
Q: My children have been covered by our state plan, but my income changed and now we’re not eligible for that. Can I enroll them in the C&MA Plan?
Yes, you may enroll the affected dependents within 30 days of their involuntary loss of other coverage.
Q: My wife and I are having a baby. What do we need to know?
Congratulations and enjoy this time!
- First, please make a note to enroll your baby within 30 days of birth to avoid unpaid claims
- Talk to Highmark and your provider about billing and maternity coverage so you will know what to expect
- Learn about pre-certification for hospital admission – call the number on your ID card ahead of time
- You may wish to enroll in Baby Blueprints for helpful information and gifts
- If you want to add life insurance, you may do so within 30 days of birth
Please contact Alliance Benefits if you have any questions.
Q: My child is graduating from college: when will his/her health coverage end?
It’s possible your child is still your eligible dependent even after graduation. Please check this list and inform us within 30 days when your child no longer meets this definition:
- Up to the age of 26 if they are not eligible for coverage by another employer plan
Q: My child is disabled, can they stay on the health plan past age 26?
Unmarried children over age 19 who are not able to support themselves due to mental retardation, physical disability, mental illness or developmental disability are eligible. Proof that dependents meet the criteria may be required.
Q: My grandchild lives with us. May I enroll my grandchild in the Health Plan?
You may enroll a child who is legally placed for adoption, or for whom you or your spouse is the legal guardian. If these situations apply to your grandchild, he or she would be eligible.
Q: I am adopting a child. When does coverage start and how can I enroll my child?
Coverage begins either at adoption or placement for adoption. Please complete the Enrollment and Change Form and fax or mail to Alliance Benefits within 30 days, along with a copy of your legal paperwork.
Q: I'm getting married and my new spouse has children. Can I enroll them?
Yes, you may enroll your new spouse and stepchildren within 30 days of the wedding. Please use the Enrollment and Change Form.
Q: If I forget to enroll my baby within 30 days, what will this mean in terms of claims? Will the birth still be covered?
Claims for the birth will be paid under the mother’s health insurance. However, pediatrician visits for well baby care or other medical treatment for your baby will not be paid if there is a late enrollment.
Q: If my baby is a late enrollment, when will my baby’s coverage start?
If you enroll more than 30 days after birth or adoption, a six-month waiting period begins when all completed paperwork is received. Health coverage begins for your newborn, adopted child, or stepchild the first day of the month following the end of the six-month waiting period.
For example, if your baby is born March 23 and Alliance Benefits receives a completed enrollment on May 15, the waiting period is from May 15 – November 15. Your baby’s coverage will begin on December 1.
Q: I called Highmark to ask about my 19-year old’s claim but they couldn’t give me information. Why is that?
When your child is no longer a minor, all medical providers and insurance companies must maintain confidentiality and are very restricted in giving information to you as the parent. If your child wants more involvement from you, they may request a HIPAA confidentiality agreement from Highmark (or from a provider) which would authorize sharing more information.