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Dependents

Disabled Adult Children can stay on Parent’s Health Plan past age 26

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California Law – Disabled Child – 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:

FAQ’s

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What does #ChieflyDependent mean?

“Chiefly dependent”  means 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., NY.Gov * Covered CA  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 * 

IRS Definition of Dependent section §152.  *  IRS Interactive Assistant * IRS Publication 501 on Dependents

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!

FAQ’s 

 

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What is
#Self Sustaining Employment?

 

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 *

 

FAQ’s

Legal Duty to support adult disabled children?

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Specimen Individual Policy #EOC with Definitions

Employer Group Sample Policy

It's often so much easier and simpler to just read your Evidence of Coverage EOC-policy, then look all over for the codes, laws, regulations etc!  Plus, EOC's are mandated to be written in PLAIN ENGLISH!

Specimen Policy with Definitions

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Earning too much for Medi-Cal??? Get Covered CA Quote here

Hitler & Mental Health Disabilities T 4 

Translation for the poster below:

"This person suffering from hereditary defect  costs the community $60,000 Reichsmark during his lifetime. Fellow German, that is your money, too. Translation & Image Courtesy of Psychology Fantom.com 

nazi t 4 program

 

Under  the T 4 program,  wikipedia.org T4  Certain German physicians were authorised to select patients "deemed incurably sick, after most critical medical examination" and then administer to them a "mercy death" (Gnadentod).[7] The T4 programme stemmed from the Nazi Party policy of "racial hygiene", a belief that the German people needed to be cleansed of racial enemies, which included anyone confined to a mental health facility and people with simple physical disabilities.[31]  wikipedia.org T4  

The annual cost for a bed in a CDCR-operated, inpatient psychiatric program is around $301,000 lao.ca.gov * 

Speak up!  Do want you can to make sure this doesn't happen in the USA!  

#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

Dependents
Dependents

 Tax #Filing Status

IRS Publication 501

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Be sure to put in our AGENT # 2094784

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California

Guide to #Contract Interpretation 

  • Read the Statute – Policy
  • Read the Statute – Policy
  • Read the Statute – Policy
    • Then when you think you understand it, read it again

guide to contract interpretation

Our webpage on

#SocialSecurityDisability
Factors in Evaluating 

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.
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
  Compassionate Allowances program identifies claims where the applicant’s disease or condition clearly meets Social Security’s statutory standard for disability.

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 & Care Givers

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

 

FAQ's 

 

 

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#Attorney  's that can help you through the Social Security Disability maze

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

Employee’s guide to #COBRA –
Department of Labor

employees guide to COBRA

*********

Art Gallagher Employers Guide to COBRA 

employer guide to cobra

 

 

 

Medi Cal Contact Information

#Email  Addresses & Phone #'s: 

 

 

Ombudsman

  • Ombudsman Webpage
    • Phone: 1-888-452-8609
    • Email:   [email protected] 
      • The Office of Ombudsman cannot approve/terminate/reinstate Medi-Cal eligibility; alter aid codes, change/update addresses, change/update name or initiate inter-county transfers.

Complex Questions Assistance

Medi-Cal for All Children program 

SB 75 Eligibility and [email protected]

Medi Cal - #County Office Lookup

See our Main Webpage on Medi Cal contact information

Top 5 - 10 causes of Long Term Disability Claims 

Lower back disorders  ♦   Depression  ♦ Coronary heart disease, arthritis and pulmonary diseases  (Met Life) ♦  Disability Can Happen  ♦  CDC Statistics

Top 5 causes of Disabilty

 

Our webpage on  Disability Payments - Insurance 

Get Disability Quotes for Parents, Caretakers & Wage Earners  

Learn about Private Disability Coverage

What Parents Need to Know about #Special Needs Trusts
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Trans America
Special Needs Trust Brochure

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#Nolo Special Needs Trusts

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FAQ’s 

What about #Selfb Insured Plans?

Answer: 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.

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;

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Excerpt of Blue Cross Small Business Application

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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

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Links & Resources

 

Child & Related Pages in Dependent Definition section

[child-pages]

Mental Health – An Essential Benefit

Anchors  chielfly dependent

80 comments on “Disabled Adult Children – over 26 – stay on parents insurance”

  1. If a disabled adult child (DAC) woman receiving SSDI through the pickle program
    marries a man with no income because of his own disability and is not on SSI or SSDI
    because he has affluent parents that make enough to care for him,
    will the DAC women lose her monthly SSDI income and medical that her and her toddler relies on?

    Thank you so much

    Reply

  2. My son is 32 and disabled and on my Aetna plan as a disabled adult. I will be turning 65 soon and thus going on Medicare. Will he loose his coverage under Aetna? If I choose a supplemental Aetna medicare plan, will he be able to stay on Aetna?

    Reply

  3. We live in CA, our son is 28 and therefore came off our insurance two years ago.

    He is autistic and we didn’t realize he might still be eligible to remain on our policy (through my employer – bcbs ppo) indefinitely as we support him as he is unemployed/underemployed due to autism.

    Are autistic children eligible and if so how absolus we proceed?

    Reply

    • Please contact your employer’s HR department and get a copy of the evidence of coverage and the forms, then we can review and see.

      It doesn’t seem that the question has been asked before about their being a lapse in coverage.

      It’s not if autism is covered, it’s if your son is chiefly dependent on you and is incapable of self sustaining employment.

      Reply

  7. I have a disabled son aged 32 years, who is covered under my employer’s group health insurance plan as the primary and Medicaid as the secondary insurance.

    He has been disabled since birth and has been on my employer’s group health insurance plan prior to age 26. He requires to undergo a medical procedure that is not covered under my employer’s plan but covered under Medicaid.

    I would like to temporarily terminate my son’s coverage from my employer’s health plan and continue with Medicaid so that he can have his procedure done.

    Can I do that?

    If so, can I re-enroll my son in my employer’s plan after the procedure?

    Reply

    • Do NOT cancel the Employer Plan!

      While your Employer Plan is primary, that just means they get billed first. So, if the Employer Plan pays nothing, then Medi Cal will get the bill. It does NOT mean, that you have to go to MD’s on the Employer Plan first!

      I’m sure if you ask Rando’s at the Insurance Company or Medi Cal, they will tell you something else, but unless they can show it to you in writing, IMHO it’s not worth the dime to call them.

      See our webpage on Dual Coverage.

      You may not quote anything I say or that you think I say. You may only refer to the actual footnotes to the law or actual Insurance Company EOC Evidence of Coverage.

      Reply

    • I am widowed and employed by a city, who has continued to keep my special needs daughter on after the age of 26.

      I am retiring in about 2 years and I receive retirement health care.

      How long does my daughter get to stay on? when I retire? or social security age? or death?

      Please help?

      Reply

  8. Hi, I have a 24 yr old with schizophrenia, and run across your web site trying to find resources for them (specifically a Special Needs Trust which I just had learned about).

    I wanted to ask questions about signing them up for Medi-Cal and accessing LA County resources for mental health.

    My kid is covered by Blue Cross PPO through my policy which is with USC.

    I would love to discuss also how to prepare to get my kid coverage after my policy does not cover them once they are 25 years old, or maybe my kid needs to file for disability in order for my policy to cover what they need.

    Would love your help with all these topics! I never knew that people like you existed…

    Thanks for all the resources on your web site, and look forward to hearing from you.

    Reply

  9. 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

     

    Reply

  10. 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

    Reply

  11. Question What about Self Insured Plans?

    Answer
    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.

    See above for more information

    Reply

  12. Would 10277 d apply if my disabled son is on his father’s plan, is now turning 26 and my X husband no longer wants our son on his Insurance?

    Reply

  13. My son’s father’s employer is refusing to drop our son from his health insurance they are saying we need a court order to take him OFF the 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.

    Reply

  14. 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.

    Reply

  15. 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

    Reply

  16. 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.

    Reply

    • Medicare eligibility?

      I don’t know about getting Medicare just because your Dad is getting Social Security. Were you on SSI? SSDI? Try these links:

      https://socialsecurity.healthreformquotes.com/ssi/

      https://medicare.healthreformquotes.com/sign-medicare/rules-get-part-hospital-medicare-no-charge/

      https://www.medicareadvocacy.org/medicare-info/medicare-coverage-for-people-with-disabilities/

      If you find a citation showing that you can get Medicare based on your Dad getting Social Security, please post it!

      Reply

      • Hi. Thank you for the links.

        Because I was determined to be disabled before the age of 22, I will receive Social Security benefits not based on my work record but on one of my parents’ work record. Once a parent is eligible for benefits I receive 50% of their social security income as an SSDI benefit. If they were deceased, I would receive 75%.

        The information is on the Social Security web-site:

        Adults Disabled Before Age 22

        An adult disabled before age 22 may be eligible for child’s benefits if a parent is deceased or starts receiving retirement or disability benefits. We consider this a “child’s” benefit because it is paid on a parent’s Social Security earnings record.

        The “adult child”—including an adopted child, or, in some cases, a stepchild, grandchild, or step grandchild—must be unmarried, age 18 or older, have a disability that started before age 22, and meet the definition of disability for adults.

        https://www.ssa.gov/planners/disability/qualify.html

        In my case, because both of my parents have been working full time, I have been eligible for SSI based on my lack of resources and income and for Medicaid based on my disability and lack of income. Once my dad retires the situation changes in that I will receive SSDI. Some people in that case would also continue receiving SSI if the SSDI benefit was below a certain thresh-hold (based on how long the parent worked and earned). In my case I will just receive SSDI. I will also be eligible for Medicare. But because I will also still be in the income group eligible for Medicaid, I believe I will have the CCC Plus plan—although that is the part that the social worker wasn’t as sure about. It was being rolled out slowly, but she thinks now everyone may have to go on it.

        I was able to find my private insurance policy I have now through my dad’s work and it looks like I could stay on but only if I paid the premiums which would be more than I will receive in SSDI. I did find a policy in Connecticut for the same insurance company where a disabled dependent can stay on one year without paying premiums after the policy ends for the employee, but that’s not the case in our state/plan.

        Thank you for the provider search link for CCC Plus. It’s confusing because it seems more providers take Medicare or Medicaid than take one of the 6 managed care programs they’re putting CCC Plus people into. For example, I can see I would be able to continue seeing my PCP on some of the plans but not others, but I know he takes Medicare. And then I wonder if I’d be locked into that plan. I’m not sure how common acceptance of those CCC Plus plan is versus regular Medicare. I wonder if I’d be better off getting rid of Medicaid (if I’m allowed to even though I’m eligible) and paying for supplemental insurance for Medicare once I start receiving that. Something I will have to research more. But the provider search is a good start so I can check which of my current providers are covered by the 6 different plans.

        Thank you again.

        Reply

  17. 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

    Reply

  18. 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

    Reply

    • 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.

      Reply

  20. 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.

    Reply

  21. 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

    Reply

    • 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/

      Reply