[UCRDBR] Health Net - Change to the review process for Overage Dependents as of 12-02-2024

[Departmental Benefits Representatives]

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December 4, 2024

To:
Department Benefits Representatives (DBRs)
From:
Central HR Benefits Office
Re:
Health Net - Change to the review process for Overage Dependents as of 12-02-2024

DBRs, please share this information via your internal listserv.  Do not reply to this email.  Please
send a separate email with questions to benefits at ucr.edu<mailto:benefits at ucr.edu>.


The Health Net Disabled Dependent Certification (DDC) form is used to certify that a dependent child is incapable of self-support due to a continuously disabling illness or injury. Health Net will mail a DDC form (also available on https://uc.healthnetcalifornia.com/forms.html) with instructions 90 days before a dependent's coverage terminating date for the subscriber and dependent's physician to complete and submit back to Health Net. This form helps Health Net to determine the eligibility of the dependent to remain covered under a UC member's health plan after age 26. The form requires information about the dependent and the subscriber, and it must be completed by both the subscriber and the attending physician. Supporting documentation may also be required to provide details about the nature and extent of the disability.

While the process itself has not changed, the routing or review team has. The subscriber will still need to submit the completed DDC form, but it is now routed and handled by another area within Health Net's membership team, where the case coordinator will review the forms.

This change will expedite the process compared to the previous timeframe, which took up to 10 days and, in some cases, 30 days. The new process should take approximately 5 days.

Regarding appeals: If Health Net determines that a dependent does not meet the criteria, a notice stating the reason for the denial will be issued. Thereafter, the member can submit an appeal on their own behalf through the Health Net site or contact Health Net directly to obtain assistance in submitting an appeal.  The latter option is recommended.

The appeal process typically takes 30 calendar days for standard submissions or 72 hours for submissions considered urgent (though these determinations are usually handled as standard submissions).

To start the appeal process, the member should contact the Health Benefit Navigators at 1-800-539-4072. A representative can open a case and file an appeal or grievance for the member.

Information on Continuation of Coverage for Overage Disabled Children by medical plans can be found in the Group Insurance Regulations, Part II-D Continuation of Coverage - Overage Disabled Children PDF<https://ucnet.universityofcalifornia.edu/for-hr-administrators/health-welfare-benefits/group-insurance-regulations/>.


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