Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerPolicy UpdatesClinical/Medical PolicyUniversity Health Alliance extended dependent cove…
    Ask Trek AI about this page
    CurrentUniversity Health Alliance (HSA)Policy MPP-0118-160101

    Eligibility for Dependents with Disabilities (Extended Dependent Coverage)

    Customize your policy alerts

    Sign up for University Health Alliance (HSA) Policy MPP-0118-160101 alerts

    Get alerted when Policy MPP-0118-160101 changes without checking for updates manually.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    Defines UHA coverage criteria, documentation, limitations, and administrative requirements for extending dependent coverage for members with disabilities under University Health Alliance plans.

    Policy Summary
    PayerUniversity Health Alliance (HSA)
    PolicyEligibility for Dependents with Disabilities (Extended Dependent Coverage)
    Policy CodePolicy MPP-0118-160101
    Change TypeNo material change
    Effective DateAug 1, 2022
    Last ReviewAug 1, 2022
    Next Review Date
    Key ActionEmployee must submit a completed Dependent Disability Certification Form and required supporting documentation (e.g., Social Security disability letter or CMS ID) within required timeframes.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    26age threshold
    31documentation window (days)

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    annual
    documentation review frequency
    noneprior auth

    Eligibility for Extended Dependent Coverage

    Eligibility for Extended Dependent Coverage

    Covered when ALL of the following are met:

    Dependent disability criteria: a) Child is incapable of self-sustaining employment due to a physical or mental disability; b) Child's disability existed before the child turned 26 years of age; c) Child relies primarily on the UHA member (parent or legal guardian) for support and maintenance as a result of their disability; d) Child is enrolled with UHA under this coverage or another qualified health insurance coverage and has had no break in health insurance coverage since before the child's 26th birthday; e) Child has obtained a Social Security disability certification letter or an identification card from the Centers for Medicare & Medicaid Services (CMS).age <26 at onset; documentation submitted within 31 days of 26th birthday; UHA may request updates no more frequently than annually

    All items must be supported by documentation. Employee must submit a completed Dependent Disability Certification Form (physician-completed) and copies of the dependent's Social Security disability certification letter or CMS identification card. UHA medical leadership (Chief Medical Officer and/or Medical Director) will review submitted forms to determine qualification.

    Coverage is not extended when the dependent no longer meets UHAs requirements for a disabled dependent. Specifically, coverage is extended only so long as the dependent remains incapable of self-sustaining employment, relies primarily upon the UHA member for support and maintenance, and is not married. If any of these conditions cease to be true, extended dependent coverage will not be continued. [

    Dependent Age Limit and Administrative Timing

    Dependent age limit — key facts
    Dependent age limitUnder 26 years
    Renewal/request frequencyUHA may request updated documentation subsequently, but not more frequently than annually

    Provider Requirements, Documentation, and Denial Conditions

    Prior Authorization

    Prior authorization not applicable

    Prior authorization is not required for extended dependent disability coverage; prior authorization is not applicable under this policy.

    Note

    Attestation, tax returns, and retrospective review

    Subscriber must submit an attestation and copies of their tax returns validating the dependent's legal status; UHA may perform retrospective review to validate payment determinations.

    Documentation Required

    Required documentation to support extended dependent coverage

    Policy Background and Alignment with Federal Definitions

    University Health Alliance aligns its approach to dependent disability with federal disability concepts and operationalizes those concepts for benefits administration. For eligibility UHA requires evidence that the childs disability existed before the child turned 26 years of age and that the child relies primarily on the UHA member for support. UHA accepts a Social Security disability certification letter or a CMS identification card as part of the required documentation, and all determinations are reviewed by UHA medical leadership (Chief Medical Officer and/or Medical Director). Documentation must be submitted by the employee within 31 days of the childs 26th birthday and may be requested subsequently but no more often than annually.

    Definitions of Disability

    Disability — federal nondiscrimination definition
    Definition (federal nondiscrimination laws)A person with a disability is someone who: 1) has a physical or mental impairment that substantially limits one or more major life activities; 2) has a record of such an impairment; or 3) is regarded as having such an impairment.
    Statutory examplesIncludes definitions used in the ADA, Section 503 of the Rehabilitation Act, and Section 188 of the Workforce Innovation and Opportunity Act.
    Contextual noteUHA recognizes the term 'disability' consistent with federal definitions, which vary by government entity and context.
    Disability — Social Security definition
    Social Security definitionA severe disability (or combination of disabilities) that has lasted or is expected to last at least 12 months or result in death, and which prevents substantial gainful activity or performing previous work or adjusting to other work because of the medical condition.
    Policy Summary
    PayerUniversity Health Alliance (HSA)
    PolicyEligibility for Dependents with Disabilities (Extended Dependent Coverage)
    Policy CodePolicy MPP-0118-160101
    Change TypeNo material change
    Effective DateAug 1, 2022
    Last ReviewAug 1, 2022
    Next Review Date
    Key ActionEmployee must submit a completed Dependent Disability Certification Form and required supporting documentation (e.g., Social Security disability letter or CMS ID) within required timeframes.
    SourceLink
    On This Page
    Eligibility for Extended Dependent CoverageDependent Age Limit and Administrative TimingProvider Requirements, Documentation, and Denial ConditionsPolicy Background and Alignment with Federal DefinitionsDefinitions of Disability

    Employee must submit a completed Dependent Disability Certification Form completed by the dependent's physician and copies of the dependent's Social Security disability certification letter or CMS identification card; proof of continuous coverage may be requested and documentation must be provided within required timeframes.

    • Dependent Disability Certification Form completed by the dependent's physician (form available on UHA Employers' Forms and Documents page).
    • Copies of the dependent's Social Security disability certification letter or CMS identification card.
    • Submit documentation at least 31 days prior to the dependent's 26th birthday and provide documentation within 31 days of the 26th birthday; UHA may request updates but not more frequently than annually.
    • Subscriber attestation and copies of tax returns validating dependent's legal status may also be required.
    Denial Risk

    Conditions that trigger denial of extended dependent coverage

    Coverage may be denied if the dependent no longer remains incapable of self-sustaining employment, is married, does not rely primarily on the UHA member for support, or if required documentation is not provided within the required timeframes.

    • Dependent becomes married.
    • Dependent regains ability to self-sustain employment.
    • Dependent does not rely primarily on the UHA member for support and maintenance.
    • Required documentation not submitted within 31 days of the dependent's 26th birthday or as requested.
    • Break in health insurance coverage since before the dependent's 26th birthday.
    Duration requirementMust have lasted or be expected to last at least 12 months (or result in death).
    Work impactMust prevent working at a substantial gainful activity level or performing/adjusting to other work.