Understanding Dependent Rules

Dependent rules are used by health benefit plans (1X plan types) to establish age-related limits on dependent eligibility for health plan coverage. You can establish general age limits and a separate age limit for dependents who are students. Additionally, you can make disabled dependents eligible regardless of age, and you can make married dependents ineligible regardless of age.

Dependent rules are associated with specific plan types within a benefit program. For example, a particular benefit program must use one dependent rule for all of its medical plans (plan type 10), but you can use a different dependent rule for the dental plans (plan type 11) in that program, and you can use different limits for a different program.

Default Dependent Rules

Within a benefit program, plan types are not assigned a dependent rule use these default rules:

Setting	Default Limit for Plan Types With No Dependent Rule ID
Dependent Age Limit	99
Student Age Limit	99
Exclude Disabled from Age Limit	Yes (check box selected): disabled dependents are eligible for coverage regardless of age.
Dependent Ineligible if Married	No (check box not selected): married dependents are not disqualified from coverage.

COBRA Processing

To generate COBRA event triggers during COBRA overage processing, the system uses the most restrictive settings from the dependent rules used by all of the 1X plan types under the benefit program, as described in the following table:

Setting	Value Used for COBRA Overage Processing
Dependent Age Limit	Lowest value in use in the benefit program.
Student Age Limit	Lowest value in use in the benefit program.
Exclude Disabled from Age Limit	No (check box not selected) as long as at least one plan type in the benefit program has this value. Otherwise, Yes (check box selected).
Dependent Ineligible if Married	Yes (check box selected) as long as at least one plan type in the benefit program has this value. Otherwise, No (check box not selected).

The system uses these settings only when creating the initial COBRA event triggers. When the system processes the triggers to generate COBRA enrollments, it correctly applies the rules for specific plan types.