Dependent Verification Form

WHEN DOES DEPENDENT COVERAGE END?

Has your child left for college?  You will need to fill out the:

Dependent Student Verification Form

The coverage will be terminated  when the child turns 19 unless you verify  your child attends college full-time. It is  your responsibility to complete the form.  Any claims after that date will be your  responsibility to pay. 

Dependent coverage will end on the earliest of the following events:

1. Your coverage ends;

2. The dependent ceases to be an eligible dependent due to divorce, separation, or death;

3.  Termination of coverage for a post-secondary student not returning to school is the last day of the month of last enrollment (Students transferring to another school have 90 days to re-enroll); 

4. The last day of the month the dependent reaches 25;

5. You stop making any payments required for dependent coverage;

6. The Plan is changed to terminate coverage for all dependents.

Please return the documentation to:

enrollment.T12@90degreebenefits.com

Or mailed to:

90 Degree Benefits

Attn: Enrollment Department

290 South Lambert Road Suite 4

Orange, CT  06477