If the child is currently enrolled in the state group health insurance plan and incapacitation was prior to age 26, they may continue coverage as long as they continue to meet eligibility requirements. Members will have to submit the Certificate for Incapacitation for Dependent Child Application prior to the child's 26th birthday. The insurance carrier will decide if a dependent is eligible based on disability. In some cases, members will have to resubmit certification as required by the insurance provider. Coverage will end and will not be restored once the child is no longer disabled.
The Certificate for Incapacitation for Dependent Child Application is located here: https://www.tn.gov/content/dam/tn/finance/fa-benefits/documents/0927.pdf
Under the Grandfathered Clause in Plan Document:
For Agencies joining the State Group Insurance Plan-
Dependents of active employees who do not meet the plan’s definition of dependent may be enrolled when the agency joins the plan for the first time. This includes incapacitated children.
The agency must provide a copy of the dependent definition from the previous carrier and proof of former coverage to the plan when requesting approval for a grandfathered status for the dependent.
Please note: It is the responsibility of the Head of Contract (HOC) to keep up with the expiration date of the incapacitation. Neither Benefits Administration nor the insurance carrier will notify the HOC when an incapacitated dependent is about to lose coverage.