Apply for over-age dependent coverage
How to make this change
Use this form to apply for coverage for a child who is no longer a minor but is fully dependent on you financially.
- Print this form and complete sections 1 to 3. Remember that you need to attach your child’s most recent education assessment.
- Ask your child’s doctor to complete section 4.
- Once completed, mail it to the address on the form.
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Use this form to apply for over-age dependent coverage. You’ll need the doctor to fill in some sections.
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