How long can a disabled child stay on parents health insurance?

CA law allows your incapacitated, handicapped, mentally ill or disabled child over 26 to remain on the parents group or individual policy, indefinitely, as long as they were disabled before that.

An individual or group health insurance [“Health Insurance” … shall mean a  policy that provides coverage for hospital, medical, or surgical benefits. §106 ]  policy that provides that coverage of a dependent child shall  terminate upon attainment of the limiting age [26 ACA] for dependent children specified in the policy, shall also provide that attainment of the limiting age shall not operate to terminate the coverage of the child while the child is and continues to meet both of the following criteria:

(1) Incapable of self-sustaining employment by reason of a physically or mentally disabling injury, [AB 88] illness, or condition.

(2) Chiefly dependent upon the policyholder or subscriber for support and maintenanceWikipedia Child Support –  Maintenance * Maintenance * CA Insurance Code § 10278§10277  * for Group Policies Self Insurance Plans §10124  10118

Please read the law above THREE times and the definition
from one Court Case below, before asking us about this law.

Here’s our research on if the Insurance Code mandates that Self Insured ERISA Plans have the same rules.

What does chiefly dependent mean?

chiefly dependent”  to mean that the person receives fifty per cent or more of his/her support from his/her parent(s), the insurance contract itself does not define “dependent.” The United States Court of Claims held in Odlin v. U.S., 74 Ct. Cl. 633, 636 (1932), that “chiefly dependent” does not have an explicit definition but rather “each case…must stand upon its own particular facts, and that no hard and fast rule can be laid down arbitrarily fixing the value of property, or the amount of income received…as entirely determinative of the question as to whether [a person] is ‘dependent’ within the meaning of the law.”

While the company’s interpretation of the phrase “chiefly dependent” doesn’t appear to be unreasonable, only a court of competent jurisdiction may make a conclusive determination.   Odlin v. U.S.  *  New York State Analysis

View more cases?  Try Findlaw.com

If your child is dependent on you, consider life insurance to take care of your child when you are gone. Disability in case you get ill and can’t work and Long Term Care, in case you can’t take care of yourself.

In Covered CA, (we are authorized agents) there may be issues with subsidies – MAGI Income.

Considering that everything is guaranteed issue, with no Pre X starting 1.1.2014, I didn’t  think this page would be relevant anymore, but it gets a ton of hits!

What is
Self Sustaining Employment?

1: maintaining or able to maintain oneself or itself by independent effort  – self-sustaining community

2: maintaining or able to maintain itself once commenced – self-sustaining nuclear reaction Webster

 

IRC Internal Revenue Code §152(c)(3)(B):
Definition of Dependent

Special rule for disabled.

In the case of an individual who is permanently and totally disabled (as defined in section 22(e)(3)) at any time during such calendar year, the requirements of subparagraph (A) shall be treated as met with respect to such individual.

IRC §22(e):
(3) Permanent and total disability defined.

An individual is permanently and totally disabled if he is unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months. An individual shall not be considered to be permanently and totally disabled unless he furnishes proof of the existence thereof in such form and manner, and at such times, as the Secretary may require. The ABD Team *

New York State Analysis if Insurer must continue coverage beyond age 26 for disabled child

IRS Interactive Assistant

IRS Publication 501 – Search for rules on determining support

IRS Worksheet for Determining Support 
Publication 501

Social Security
Factors in Evaluating Disability

Table of Contents

DISABILITY DETERMINATIONS

600. Who qualifies for disability determinations?
601. What is a “medically determinable” impairment?
602. Impairment Lasting or Expected to Last at Least 12 Months
603. Definition of Substantial Gainful Activity
604. Independent Determinations Under the Social Security Act
605. Does SSA make disability determinations on a disability-rating schedule?

MEDICAL EVIDENCE

606. Medical and Other Evidence as Basis for Decision of “Not Disabled”
607. Medical Evidence as Basis for Decision of “Disabled” — Listing of Impairments

DISABILITY EVALUATION

608. What if your condition does not meet or medically equal a listing?
609. Evaluation Considering Age, Education, and Work Experience
610. What does “work that exists in the national economy” mean?
611. Does your employment condition affect a disability determination?

EVIDENCE OF DISABILITY

613. Are you considered disabled if you are receiving treatment for an impairment?
614. Evidence of Disability
615. Categories of Evidence
616. Consultative Examinations

SUBSTANTIAL GAINFUL ACTIVITY

617. Importance of Substantial Gainful Activity
618. How does work at the substantial gainful activity level affect disability?
619. Definition of “Activity”
620. Significance of Earnings
621. How are your earnings as a self-employed person considered in determining substantial gainful activity?

DISABILITY STATUS CEASES

622. When are continuing disability reviews conducted?
623. When does disability end?

Parents & CareGivers

Check out our webpage on getting your own private disability coverage, in addition to Social Security Disability or SDI State Disability Coverage

Get FREE Instant Individual & Family  California  Quotes – Including Tax Subsidy Calculation – Guaranteed Issue – No Pre-X Claus

Get FREE Instant Quotes - Including Tax Subsidy Calculation - Guaranteed Issue - No Pre-X Clause

Full Instructions to use Individual Quote Engine

 

Excerpt from “typical” Group plan:

4) If coverage for a Dependent child would be terminated because of the attainment of age 26, and the Dependent child is disabled and incapable of self-sustaining employment, Benefits for such Dependent child will be continued upon the following conditions:

a) the child must be chiefly dependent upon the Subscriber, spouse, or Domestic Partner for support and maintenance;

b) the Subscriber, spouse, or Domestic Partner must submit to Blue Shield a Physician’s written certification of disability within 60 days from the date of the Employer’s or Blue Shield’s request; and

c) thereafter, certification of continuing disability and dependency from a Physician must be submitted to Blue Shield on the following schedule:

i. within 24 months after the month when the Dependent child’s coverage would otherwise have been terminated; and

ii. annually thereafter on the same month when certification was made in accordance with item (1) above. In no event will coverage be continued beyond the date when the Dependent child becomes ineligible for coverage for any reason other than attained age.  * [See also Conditions of Enrollment Page B 56 *  Dependent Definition Page B 70] EOC

Links & Resources

Mental Health Benefits are an essential benefit under Health Care Reform.  

Dental Coverage can be purchased here.

Dual Coverage – Which Insurance Company pays first?  Medi-Cal, SSI, SSDI?

tacanow.org Autism Website 

Special Needs Trusts  

 

Proofs Required for Disabled Child – Click to enlarge  — 

If you have other questions – or want to make sure this is the most current information

Please post in the ask a question area below
Proofs Required for Disabled Child

Employee’s guide to COBRA –
Department of Labor

employees guide to COBRA

EmployER’s Guide  

*********

Art Gallagher Employers Guide to COBRA 

COBRA Continuation Coverage?
Who Is Entitled
COBRA Rights and Responsibilities:
Notice and Election Procedures
Benefits
Duration
Summary of Qualifying Events,
Qualified Beneficiaries
Paying for it

Our Webpage on COBRA    *    Cal COBRA 

Get Individual Guaranteed Issue ACA/Obamacare Quotes 

Subsidies if you make less than 600% of Federal Poverty Level!

No Pre X Clause!

No wait for Open Enrollment as you get Special Enrollment when you lose COBRA or your Employer Group Plan!

Dependents
Dependents

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Our Webpage on Insurance Coverage for 

COVID 19

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Most of what the video says is RIGHT, not grandfathering though. Let me know if you find a video more on point

80 comments on “Disabled Children – over 26

  1. THE DUTY TO SUPPORT ADULT DISABLED CHILDREN

    The Basics

    California requires that the parents of adult children with incapacities support those children if possible. Family Code section 3910 states,

    “The father and mother have an equal responsibility to maintain, to the extent of their ability, a child of whatever age, who is incapacitated from earning a living and without sufficient means.”

    Incapacitated From Earning a Living

    A child is incapacitated from earning a living if the child demonstrates “an inability to be self-supporting because of a mental or physical disability or proof of inability to find work because of factors beyond the child’s control.”  Courts have been liberal in meeting this standard when dealing with the mental health of adult children and found the incapacity in the following cases to be sufficient.

    In Chun v. Chun, a father was ordered to support an “emotionally disabled” adult child with a twelve-year-old maturity level.

    In re Marriage of Drake dealt with a parent who was ordered to support an adult child with chronic paranoid schizophrenia.

    Farber v. Olken involved an adult child who was mentally ill.

    In order to demonstrate that an adult child has an incapacity sufficient for adult child support, an independent medical exam (IME) is required. In fact, for every adult child support case, an IME should be considered, even if the parties stipulate to the fact that the adult child is incapacitated. An IME will set a benchmark for the adult child, which will allow medical professionals to measure the extent of the adult child’s incapacity and the likelihood of the adult child developing a marketable skill set.

    Without Sufficient Means

    “[T]he question of ‘sufficient means’ should be resolved in terms of the likelihood a child will become a public charge.”

    The principle that society should not bear the burden of caring for incapacitated adults who have parents with the means to do so. The “without sufficient means” inquiry concerns the issue of whether the adult child will end up requiring governmental benefits in the future.

    It is also important to determine whether an adult child is already receiving such benefits.

    See our resources & links below

    In such a case, care should be taken to avoid the loss of such benefits through the use of a special needs trust or similar instrument. Nevertheless, some may argue that a proper adult child support order should eliminate any need for government benefits. However, certain benefits are frequently crucial to the health of the adult child and may be required as part of a medical regimen. For example, an adult child, who has an established course of treatment from a doctor that the adult child visited through the Social Security Administration, may need to remain on that course in order to avoid interruptions and complications that a change in medical provider would likely cause.

    Also, the process to qualify for such benefits is fairly rigorous. A strong argument can be made that if an adult child has already qualified for government benefits, that adult child will likely qualify for adult child support.  Read full article from Orange County Bar

     

    Children Are Like Diamonds: Forever.  Only, More Expensive: A Primer on California Family Code section 3910(a), the Most Terrifying, Most Common Sense Law You’ve Never Heard Of, but Should Have  Read Article Alameda Bar Assoc

    Wallin & Klarich Family Law

    Song Family Law

    Proper standard for definition of incapacitated?

    See Article on 50 year old attorney with depression


    child support guidelines.com

     

     

  2. If my employer switches plans or I get a new job, will my disabled child be covered under the new plan?

     

    We find that often policyholders are told that a new insurance company  says that they will only cover disabled dependent children that are already enrolled on our group plan that happen to age out, not if you transfer plans, get a new job, etc.

    Here is what we show the actual law and policy provisions to be:

    If the employee or member changes carriers to another insurer or to a health care service plan, the new insurer or plan shall continue to provide coverage for the dependent child. CA Insurance Code 10277 (d)

    A Dependent child who reaches age 26 becomes ineligible on the day before his or her 26th birthday, unless the Dependent child is disabled and qualifies for continued coverage as described in the definition of Dependent.  Page 60 of the EOC
     .
    The  Group Administration Guides says virtually the same thing.
     .
    Our wholesalers – General Agent’s website says:
    Yes, pending approval from Patient Management Group Department
    Here’s an actual EOC – Evidence of Coverage from Blue Shield for the PPO Platinum Plan.

    This caused us to lose at least one new hire, because she decided to stay on her current medical plan (with her current employer) that provides coverage for her disabled adult child.

    ***I suggest you appoint us as your agent and we will fill out the disabled child form, along with the employee application and get a WRITTEN answer, not a “bozo” oral – hearsay  (Federal Rules of Evidence) answer.

     

    ******

    I currently work for a company that provides a group health plan. I have a disabled son age 27 covered on my policy.

    I may be changing employer and going to a UC – University of California system.

    How am I able to continue coverage for him through the UC system?

    *************

    Here’s the 2018 Health Benefits Guide for the UC System.

    Page 6 Excerpt

    If you are a newly hired employee with a disabled child over age 26 or if you acquire a disabled child over age 26 (through marriage, adoption or domestic partnership), you may also apply for coverage for that child. The child’s disability must have begun prior to the child turning age 26. Additionally, the child must have had continuous group health coverage since age 26, and you must apply for University coverage during your Period of Initial Eligibility. The plan will ask for proof of continued disability, but not more than once a year after the initial certification

    See also Page 14

  3. What about Self Insured Plans?

    ************

    What does the evidence of coverage – EOC say? Please send your EOC to us or at least take a photo of your ID card with your Smart Phone and send to us. We don’t post individual identifiable information. We might then be able to search and find your EOC Evidence of Coverage and it would be so much easier to show you the benefits you have in your policy.

    Pro

    The Affordable Care Act, also known as the ACA, specifies requirements and guidelines in a number of different areas that are relevant and applicable to self-funded employers. Below is a summary of these provisions.

    Disabled children who meet the requirements for enrollment, however, do not become ineligible at age 26. Providence.org

    ADA NCBI.NLM.NIH.gov

    The ADA protects against disability-based discrimination in employment, governmental and commercial activities, transportation, and telecommunications.

    ADA Title V allows bona fide insured or self insured employee benefit plans to make some health-related distinctions for risk classifications based upon, or not inconsistent with, state law.

    However, all such provisions are allowable under the ADA only if they meet the requirements of applicable state law and are not used as a subterfuge

    Disability-based distinctions involving dependent coverage will be analyzed in the same fashion as disability-based distinctions in employee coverage Cornell.edu

    The Department of Labor has instituted disability nondiscrimination regulations which may apply to those with “health factors.” The regulations are complex; setpnowskilaw.com

    Con

    CA Department of Insurance does not regulate Self Insured Plans Insurance.CA.Gov

    Self-funded Health Plans–Federal or Governmental:

    Although the business of insurance is primarily regulated by the state, a number of federal laws contain requirements that apply to private health coverage, including ERISA and HIPAA. ERISA was enacted in 1974 to protect workers from the loss of benefits provided through the workplace; and in 1996, HIPAA was motivated by concern that people faced lapses in coverage when they change or lose their jobs.

    Most self-funded health plans operate under ERISA and are health benefit arrangements sponsored by empoyers or employee organizations. Under a self-funded arrangement, the employer retains the responsibility to pay directly for health care services of the plan participants.

    In Connecticut, self-funded health plans cover approximately 50% of the privately insured citizens.

    ERISA does not require employers to establish any type of employee benefit plan, but contains requirements applicable to the administration of the plan, such as requirements for disclosure, reporting and fiduciary standards, claims and continuation coverage.

    In general, ERI[S]A preempts state laws that would regulate the operation of health plans. Therefore, any state mandates do not apply to those covered by self-funded plans. (An exception is CT’s state employee plan, which abides by state mandates by contract).

    Self-funded governmental plans such as the state employee plan or municipal self-funded plans may be exempt from ERISA but still bound to follow other federal laws, such as the federal regulations on internal and external review processes under the Affordable Care Act or the Mental Health parity and Addiction Equity Act of 2008. Ct.Gov

    Can my child with a disability be covered after the age of 26?

    If your plan is fully insured, it is regulated by state laws in addition to federal laws Pacer.org

    ERISA

    Met Life v Mass.

    Primer on ERISA pre-emption

    ********************
    What about Governmental or Church plans, does ERISA affect those?

    See our Page on ERISA

    See 29 US Code Section 1003 (b)

    The provisions of this subchapter shall not apply to any employee benefit plan if—
    (1)such plan is a governmental plan (as defined in section 1002(32) of this title);
    (2)such plan is a church plan (as defined in section 1002(33) of this title) with respect to which no election has been made under section 410(d) of title 26;

    ***************

    Excerpt of Blue Cross Small Business Application

    ************

    Cal PERS We serve those who serve California. California Public Employees’ Retirement System

    Forms, Information and Rules on Disabled Children over 26

    Questionnaire

    Doctors Medical Report

    *****************

  4. My son’s father’s employer is refusing to drop our son from his health insurance even though he is fully covered for state funded medi-cal as he is an SSI recipient.

    My son has autism and his father’s insurance is denying recommended hours of treatment.

    We submitted a request during open enrollment and they are saying we need a court order to take him OFF the insurance.

    We need help, my son needs his services

    • Check out our pages on:

      Autism

      Medical Necessity

      Check out the clinical bulletins for the services you are looking for. Here’s one as an example.

      Aetna – Autism Spectrum Disorders

      Our webpage on Appeals & Grievances

      State of CA Independent Medical Review – Keep scrolling down

      independent medical review

      Our webpage on Medi Cal and other coverage

      What makes you think Medi Cal will pay for these services and employer group won’t?

      Medi Cal in CA is all HMO!
      https://medi-cal.healthreformquotes.com/hmo-managed-care-providers/

      Your husband employer, probably thinks they would be BUSTED if they are thought to be gaining advantage by taking the “sick” people off their group plan!

      Georgetown University Paper

      RELEVANT LAW:

      The following federal laws focus on addressing discrimination based on health status that occurs at the point of enrollment, but only tackle risk management techniques linked to coverage to a limited degree.

       Title VII of the 1964 Civil Rights Act prohibits intentional and disparate impact discrimination in the form of lesser benefits based on race; and prohibits both greater charges and provision of lesser-value benefits based on sex.

      ***I’m not sure of your ethnic background and it’s not relevant to me… BUT my local congresswoman is of what appears to be the same background and 1/2 of her posts are how the US Government discriminates against that ethic background! By the way, she’s IMHO an Idiot on Health Care as she keeps telling the people who elected her in Southern CA to go to Health Care dot gov rather than Covered CA or better yet to the local agents, many of whom I’m sure are of the same ethnic background. Please excuse my rant. Don’t forget President Trump said health care was more complex than anyone knew. He should have asked me or visited this website.

      Americans with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act of 1973 prevent any employer-sponsored plan or public insurance program operating in either the group or individual market from refusing to enroll a qualified person with a disability.

      Thus, if an employer health plan takes off a disabled person, it will “look like” it was the employers idea, not yours.

      Also, Social Services are for those in dire need, not ones who have income and employer benefits.

      I suggest you research the clinical bulletins and try IMR.

  5. my son, who is mentally disabled just turned 28

    now united healthcare is trying to kick him off saying his disability occurred after he turned 18/19

    even though they determined him to be disabled and allowed him to remain on the insurance after he turned 26.

    Is he not grandfathered? Can they just chang the rules.

  6. Where do I get the forms to document that my disabled son who turns 26 in a month so that I can keep him covered on my United healthcare insurance. I live in Florida no one seems to know.

    • Check your EOC Evidence of Coverage – Here’s our sample

      Customer Service

      For questions about services, providers, Benefits, how to use this Plan, or concerns regarding the quality of care or access to care, contact … Customer Service Department. Customer Service can answer many questions over the telephone. Contact Information is provided on the last page of this Evidence of Coverage.

      https://www.uhc.com/contact-us

      Try logging into
      myuhc.com

  7. My son is deaf and on my husband’s health insurance in sept he will be 26 can he stay on my husband’s insurance

  8. I’m disabled and on my Dad’s Group Health Plan. I am in the state of Virgnia. I have Medicaid as secondary insurance.

    My father is retiring. When he loses his insurance policy, I am under the assumption that I will no longer be eligible for that insurance either.

    He will start receiving Social Security, and I have been told at that point I will be eligible for Medicare. However, in my state people who are now on Medicare and Medicaid are being put into a new program called CCC+ It’s managed care. I am not sure if I will be able to continue seeing my current doctors on it or not.

  9. I’m covered under the state of Texas employee plan Blue Cross Blue Shield

    where can I find the forms and procedures to keep my disabled child on the program now that he has turned 26?

  10. My son is 28 years old and is severely mentally ill. He has Bipolar and has a substance abuse addiction

    We are a retired military family and have Tricare now Humana.

    I wasn’t able to provide the right paper work. Last time I sent all the documents they asked for and still I keep getting need more evidence I can’t figure out.

    • If you want to send us your paperwork privately, we can take a look at it and let you know how long it might take us to help you comply with their rules. You can then make an offer to compensate us for our time and what you expect for that payment. If it’s something simple and we can post anonymously to our website, we would likely do it at no charge as that’s how we build our website.

  11. I’m turning 26 in May my family has Cigna and I’m not sure what to do to stay on their insurance plan. I have fibromyalgia along with some other medical issues

  12. Hi,
    I have a brother who is disabled by birth. My parents have passed away and I am now his legal guardian. Is there an age requirement (for my brother) on when I would become his legal guardian for him to qualify as a dependent on my health insurance?
    Thanks
    -Maggie

    • I don’t believe he would ever be your dependent for health insurance.

      What about Medi Cal or Medicaid?

      See dependent defintion here https://employers.healthreformquotes.com/ab-1083/employer-definition/employee-definition/dependent-definition/

      and in a specimen policy here https://steveshorr.com/steveshorr/ab_1672_small_group_guaranteed_issue/Blue.Shield/2016/Eoc.platinum.201601PPO.pdf#page=71

      WOW!!! you could be right!

      3) A Dependent child is a child of, adopted by, or in legal guardianship of the Subscriber, spouse,
      or Domestic Partner, and who is not covered as a Subscriber. A child includes any stepchild, child placed for adoption, or any other child for whom the Subscriber, spouse, or Domestic Partner has been appointed as a non-temporary legal guardian by a court of appropriate legal jurisdiction. A child is an individual less than 26 years of age (or less than 18 years of age if the child has been enrolled as a result of a court-ordered non-temporary legal guardianship.
      A child does not include any children of a Dependent child (i.e., grandchildren of the Subscriber, spouse, or Domestic Partner), unless
      the Subscriber, spouse, or Domestic Partner has adopted or is the legal guardian of the grandchild.

      I’m not sure I fully understand your question… Please obtain the EOC evidence of coverage for your plan and we can double check everything.

  13. My 30 year old son is autistic and continues to receive medical insurance coverage through my group health insurance plan (Healthnet) based on my retirement from the University of California.

    He receives SSI and just received a Medicare Card in the mail that becomes effective on 1-1-19. The booklet accompanying the card is vague when it comes to deciding whether he should select or decline Medicare Part B. It states that he can sign up for Medicare part B through a Special Enrollment period at a later time without incurring a penalty as long as the family member is currently working.

    Does the same rule also apply if the parent is retired and has group insurance coverage through the prior employer?

    Thank you.

  14. I did not know my son could stay on insurance, he was diagnosed while on the policy with schizophrenia, cannot work, it has been 2 years, can I get him back on the policy

    • Good Question. Does he qualify otherwise? Still chiefly dependent on you? Do you have Medi Cal, Medicaid? Dual Coverage?

      Please send a copy of your evidence of coverage. See the sample EOC’s above, it looks like you have 24 months.

      Did you get notification about your child being able to stay on the plan if you could show he was disabled?

      (2) Chiefly dependent upon the employee or member for support and maintenance.
      (b) The insurer shall notify the employee or member that the dependent child’s coverage will terminate upon attainment of the limiting age unless the employee or member submits proof of the criteria described in paragraphs (1) and (2) of subdivision

      (a) to the insurer within 60 days of the date of receipt of the notification. The insurer shall send this notification to the employee or member at least 90 days prior to the date the child attains the limiting age. Upon receipt of a request by the employee or member for continued coverage of the child and proof of the criteria described in paragraphs (1) and (2) of subdivision (a), the insurer shall determine whether the dependent child meets that criteria before the child attains the limiting age. If the insurer fails to make the determination by that date, it shall continue coverage of the child pending its determination. https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?sectionNum=10277&lawCode=INS

      Check the appeals procedures in your EOC https://healthlaw.healthreformquotes.com/appeal-grievances/

      • My son used to be on my health insurance via my employer and was removed when he turned 26 yrs old, he is now 29 and disabled.

        Would I be able to put him back on my health insurance with my employer and have Medicaid as a secondary insurance for him?

        I am in the state of Kansas.

      • My daughter will be 26 in April 12, 2020. She was diagnosed with bipolar 1, etc etc October 2019. and is totally dependent on us since August 2019.

        Our insurance carrier, is refusing to allow her to stay on my insurance past age 26 because she wasn’t dependent on us in 2019 and 2018.

        Their premise is that if she wasn’t dependent on our taxes she is not eligible. She wasn’t disabled till very recently and before age 26.

        Please advise me on how to proceed?

  15. I have a 36 year old who is on SSI disability and want to know if I can add him to my policy with Harvard Pilgrim Health Care in Mass.

  16. I’m looking for information on adding a dependent and disabled child to a health insurance plan.

    The child is over 26 yrs old and disabled.

  17. I have a 26+ year old child deemed incapable of self support and receiving social security disability. I just started a new job and have been told she is NOT eligible for health care coverage.

    xxx healthcare is claiming they only have to extend coverage to those children who were in their insurance plans prior to age 26 regardless of my being a new employee.

  18. My son has had SSDI for 2 years and now has Medicare. He may also qualify for Medi-Cal (Medicaid)

    Would having Government or other coverage disqualify him from remaining on an individual or employer group plan from his parents?

  19. My Question is with a RETIRED California employee with a (long-term) disabled child, now age 29.

    How long can such disabled child stay on the (large employer – quasi-govt facility) company plan?

    • Our SAMPLE Evidence of Coverage on page b 54 provides that an employee can be covered after retirement in Section 2 d:

      d) When the Member is retired and age 65 years or older.

      Enrolled disabled Dependent children who would normally lose their eligibility under this health plan solely because of age, may be eligible for coverage if they continue to meet the definition of Dependent. See the Definitions section. Page B-57

      Definitions Section

      Employee — an individual who meets the eligibility requirements set forth in the Group Health Service Contract between Blue Shield and the Employer.

      See Page B 71 for the rules for dependents. Same as above.

      To know for certain, we need to see YOUR Evidence of Coverage and Group Service Agreement – Contract, otherwise is a SWAG answer.

      COBRA would be available, Heaven forbid if the employee passes away. There is also guaranteed issue ObamaCare. Get Quotes in CA. If the child qualifies, there is Medi-Cal, Medicaid.

  20. If my daughter who has documentation of her disability and its eligible for my health insurance and vision insurance will she also be able to get dental insurance even though the dental company denied the claims saying she was too old, but yet I pay for her health insurance, dental and vision?

  21. What if disabled child lives with father, and pays majority of support, but medical insurance is paid by mother through employer.

    Child will be 26 next March.

    Each parent meets only one requirement.

    Can child still be covered by mother after age 26?

    • I believe so. Both of you are still the parents. The child is still dependent on his/her parent (s)

      I’m out of country. If you haven’t resolved this with your employer’s insurance company, email me mid May

  22. What happens when the parents no longer work for an employer, or they pass away, whose coverage the disabled child – Bi Polar, is covered by?

    I like the coverage provided by Shell Oil and don’t want anything else, it would be inferior coverage.

  23. What happens if a disabled dependent over 26 gets married? Does the parents’ coverage for that person end?

    I can’t seem to find an answer to this. (California resident).

    • Good question. Is the disabled person still “chiefly dependent” on the policy holder, see above? If you do lose coverage, that would give you a special enrollment into ACA – get quotes here.

      What Insurance Company are we talking about? I can then pull the forms and proofs for that specific company.

      While this page is very popular 189 hits in the last 30 days, no one is buying Insurance from me and thus I haven’t kept up posting the revised forms. I’m happy to when asked.

      • Yes, she is “chiefly dependent” on her parents’ insurance for lifelong medical care.

        The policy holder is Anthem Blue Shield/blue Cross.

        She also received SSI benefits.

        • Please read again, at least 3 times, what chiefly dependent means. It doesn’t mean how much she needs or uses the insurance, but if her parents are supporting & maintenance for her. Please review the footnotes above that I’ve just added.

          Now that she’s married, is her husband supporting and providing maintenance for her?

          If she has SSI that provides around $1,000/month for support. Are her parents providing more than that? In addition, SSI automatically gives her Medi-Cal coverage.

          In CA telling me Blue CrossBlue Shield means nothing. They are two separate companies.

          Please send a copy of her ID card. Then I will know and can get further details. I will not post any PHI – Protected Health Information. If I do post the ID card, I will blot that out.

          • Thanks for the ID card. The plan your friend has is not one that I’m an authorized agent for. Please have her or her parents log into their “member portal” and then you can review the actual EOC full policy and the forms that BC/BS requires to prove disability. Also you can check the definition of dependent and from what I can tell in general, being married doesn’t disqualify a child. I’m concerned about “chiefly dependent.” Please review the page above again, as I just updated it.

  24. My daughter became disabled and unable to support herself at age 27.

    She had already been terminated from my company plan (a CA plan) at age 26.

    Might there be any possible way I can get her back on my CA Employer Coverage?

    • Near as I can tell, the law lets coverage end at age 26. Here’s clarification in Blue Shield’s Group plan

      A Dependent child who reaches age 26 becomes ineligible on the day before his or her 26th birthday, unless the Dependent child is disabled and qualifies for continued coverage as described in the definition of Dependent.

      I don’t see a way to get her on your bosses coverage. She wasn’t disabled prior to age 26.

      How about an Individual Plan? Free Quotes

      Cal or COBRA?

      SSI?

      Medi-Cal

      SSDI

      Medicare?

      • Doesn’t the obama care plan (Covered CA) depend on your income?

        I have a niece (>27yo) who is also low income and without a job and covered CA only allowed her to get a medi-Cal policy.

        We are hoping for fewer exclusions and more coverage choices

        • ACA – Obama Care – Covered CA only asks for your income if you want subsidies, tax credits to pay for your premiums. If you use our quote engine, you can get quotes both with and without subsidies.

          Here’s the income chart to see what enhanced silver level you might get, Medi-Cal, subsidies, etc. Again, if you don’t want subsidies, don’t ask for them. No one can force you to take Medi-Cal.

          Here’s what I have on the benefits for Medi-Cal. I don’t get paid to do Medi-Cal. If you find something about benefits that I don’t have, please post it to help your fellow website visitors.

          All new insurance plans, must have these 10 essential benefits. ACA wanted to standardize shopping around for plans, so the only real choices are doctor lists, metal levels and insurance company service – reputation.

          Do we have a special enrollment period for your daughter to get coverage now? Otherwise we have to wait till 11.1.2017 for Open Enrollment to get a plan for 1.1.2018.

  25. Do you have a sample letter of certification that I might provide to my physican? My father is employed by the UC system and I live in New Orleans so my physician may not be accustomed to preparing the certification letter.

  26. Hi,

    I understand that CA law allows your incapacitated or disabled child over 26 to remain on the parents group or individual policy, indefinitely. Where could I find out if my son, a Massachusetts resident, would be covered?

    Thanks SO much.

    Sue O

    • The first thing to check is your actual evidence of coverage – full policy. Here’s a specimen.

      It doesn’t look like Massachusetts has this feature. NCSL.Org

      Mass. Gen. Laws Ann. Ch. 175 § 108 allows dependents to stay on their parent’s coverage for two years past the age of dependency or until age 26, whichever occurs first, or without regard to age if they are incapable of self-sustaining employment due to disability.
      Young adults ages 19-26 are eligible for lower-cost insurance coverage, tailored to meet their needs, offered through the Commonwealth Health Insurance Connector. Reform summary and fact sheet, PowerPoint presentation.

      ACA Obamacare is guarantee issue. Why not just get him his own policy?

      Is your son on your policy now?

      It appears to be optional in your state, not mandatory.

      If your adult ‘child’ is mentally or physically incapable of earning his or her own living, the
      family’s private health insurance may offer Adult Disabled Dependent Coverage. You need to
      contact your insurance company to find out: 1) if this is an option, 2) the documentation they
      require from your child’s physicians, and 3) if there is an extra premium. fcsn.org

      See page 26 of a CA Individual Specimen Policy for the rules to qualify and availability.

      With Guaranteed Issue under ACA I don’t think the feature is that meaningful. Is there something I’m missing? It’s not like there a a family rate and no charge for the child, right?

  27. In the past, we were able to enroll disabled dependents with proof of prior coverage and documentation of disability, but Blue Shield says that they will only cover disabled dependent children already enrolled on our group plan that happen to age out.

    ….. ***We will answer your question here https://employers.healthreformquotes.com/ab-1083/employer-definition/employee-definition/dependent-definition/disabled-children/rules-insurance-companies-coverage-disabled-children/transfer-rules/

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