Apply for over-age dependent coverage
Have coverage through your employer or plan sponsor? You’re in the right place.
If you bought coverage through an advisor, use our personal insurance forms instead.
Make a change
Use this form to apply for coverage for a child who is no longer a minor but is fully dependent on you financially.
Step 1: Complete a claim form.
Download the form and print it, or fill it out in Adobe Reader XI or higher (not your browser) and save. You'll need to complete sections 1 to 3. Remember that you need to attach your child’s most recent education assessment.
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Use this form to apply for over-age dependent coverage. You’ll need the doctor to fill in some sections.
Step 2: Ask your child’s doctor to complete part 4.
Step 3: Submit your claim.
Once completed, mail it to the address on the form.