Dependent Aging Out: How to Maintain Plan Coverage

Under federal guidelines, dependents automatically age out and lose coverage on a Sana health plan at the end of the month of their 26th birthday.

Disability-Based Coverage Continuation

Continued coverage past age 26 is only available for dependents who are disabled (mentally or physically incapable of self-sustaining employment).

If approved for continuation:

• No Changes to Benefits: The dependent remains enrolled under the primary subscriber’s account.
• Same Plan Structure: All medical, prescription, lab, and preventive care benefits, copays, deductibles, and network coverage remain exactly the same as before.

How to Apply for Disability-Based Continuation

To request continued coverage for a disabled dependent, the plan subscriber must email the following documentation to hello@sanabenefits.com:

1. Subscriber Statement: A written statement certifying that the dependent is reliant upon the subscriber for financial support and unable to earn a living.
2. Physician Documentation: Written documentation from the dependent’s treating physician or psychiatrist clearly identifying the disability and confirming they are incapable of self-sustaining employment.

Once submitted, our team will review the documentation and provide an update within 3 to 5 business days.

Options for Non-Disabled Dependents Aging Out

If a dependent is turning 26 and does not qualify for disability-based continuation, their coverage will end on the last day of their birth month. They will need to transition to individual coverage using options such as:

• COBRA Continuation: Electing COBRA to temporarily extend their existing group health plan coverage. Please note, Employers with fewer than 20 eligible employees are not required to offer COBRA.
• Health Insurance Marketplace: Enrolling in an individual plan through Healthcare.gov or their state's insurance exchange. (Aging out triggers a Qualifying Life Event, opening a 60-day Special Enrollment Period).
• Employer-Sponsored Coverage: Enrolling in a health plan offered through their own employer.