As post-secondary students check off their to-do lists and prepare to head back to class, benefits plan administrators have a few items to check off their to-do lists, as well.

One item on that list is verifying the eligibility of dependent students. The good news? It’s largely a “set it and forget it” task. A quick review at the start of the school year can help ensure eligible students remain covered and reduce the risk of claim issues later on.

Why Dependent Student Eligibility Matters for Benefits Coverage

Most insurers require dependent children of a certain age — typically between 21 and 25, although it varies by insurer — to be enrolled full-time at an accredited post-secondary institution in order to remain eligible for coverage. If updated proof of enrolment each fall is not submitted, the insurer can quietly remove that dependent from coverage or deny claims retroactively. Missing this small but vital step may cost either the employee (denied claims) or the employer (paying premiums for ineligible dependents).

Administrators should also keep in mind that students who drop courses or take time away from school may no longer meet the plan’s definition of a full-time student.

What Happens When Dependent Student Status Is Not Updated

When student status is not reviewed or updated promptly, insurers may remove an over-age dependent from coverage.

Unfortunately, this issue is often discovered only after a claim is submitted.

This can leave students responsible for out-of-pocket expenses for prescription drugs, dental treatment or other eligible healthcare costs that they expected would be covered.

At the same time, employers may continue paying premiums for dependents who no longer qualify for coverage.

Your Back-to-School Eligibility Checklist

Before the start of the academic year:

• Confirm full-time enrolment requirements with your insurer.
• Review your insurer’s student eligibility verification deadlines.
• Remind employees to review any dependents approaching the plan’s age-out threshold.
• Communicate document requirements for student dependents before the school year begins.
• Request proof of full-time enrolment from employees, where required.
• Update employee benefit records promptly when a student’s status changes.

Questions? Contact Your Benefits Advisor

A quick review each fall can help prevent coverage issues, unexpected claim denials and unnecessary premium costs. If you have questions, contact your Navigate advisor.

Contact us today to see how we can help.