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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.

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.

Not what you’re looking for? Find the forms you need.

I have coverage through my employer

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I bought coverage through an advisor

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