- 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:
- Incapable of self-sustaining employment by reason of a physically or mentally disabling injury, [AB 88] illness, or condition.
- Chiefly dependent upon the policyholder or subscriber for support and maintenance. Wikipedia Child Support – Maintenance * CA Insurance Code § 10278 * §10277 * for Group Policies Self Insurance Plans §10124 10118
- Before asking us about this law or if you qualify.
- What about getting disability income protection for the parents & caretakers?
- Double checking if your child qualifies to stay on your plan?
- What about when employee retires?
- Retirement? Medi Cal – Medicaid?
- COBRA – CAL COBRA when parent retires or quits job?
- I’m changing employers and/or my employer is going with a new Insurance Company
- Same question…
- Self Insured Plans?
- Making changes outside of Open Enrollment?
- Dual Coverage – Medi Cal?
- Would other coverage prevent one from getting dependent coverage under this rule?
- I don’t understand all this and I need private tutoring, education or research, can we arrange that?
- Getting coverage if not on plan prior to age 26?
“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 *
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.
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!
- Only disabled say age 25 or after 26?
- Does it matter if it’s Mother or Fathers Employer? Who is child dependent on?
- maintaining or able to maintain oneself or itself by independent effort – a self-sustaining community
- maintaining or able to maintain itself once commenced – a 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.
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 — who can be claimed as a dependent
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!
- Find your own Individual EOC Evidence of Coverage
- It' important to use YOUR EOC not just stuff in general!
- Obligation to READ your EOC
- Employer Group Plans
- Medi-Cal HMO – Managed Care Providers
- Our Webpage on Evidence of Coverage
- Plain Meaning Rule - Plain Writing Act
- Our Webpage on OOP Out of Pocket Maximum - Many definitions are explained there.
#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
Be sure to put in our AGENT # 2094784
Delta Dental – Covered CA Plans
- Delta Dental Individual & FamilyTM Delta Dental PPOTM Family Dental Plan 669 KB
- Delta Dental PPOTM Children’s Dental PPO for Small Businesses 790 KB
- Delta Dental PPOTM Family Dental PPO for Small Businesses 794 KB
- Delta Dental Individual & FamilyTM DeltaCare® USA Family Dental HMO 872 KB
- DeltaCare® USA Children’s Dental HMO for Small Businesses 837 KB
- DeltaCare® USA Family Dental HMO for Small Businesses 848 KB
- Read the Statute – Policy
- Read the Statute – Policy
- Read the Statute – Policy
- Then when you think you understand it, read it again
- Plain Language Video
- Tools to Read a Statute VIDEO
- Contract Interpretation in California: Plain Meaning, Parol Evidence and Use of the Just Result Principle
Our webpage on
- jiggery pokery and contract interpretation
- Evidence of Coverage EOC
- Plain Meaning Rule - How to read Policy - Contract
Parents & Care Givers
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
All our plans are Guaranteed Issue with No Pre X Clause
Quote & Subsidy Calculation
There is No charge for our complementary services
Our Quote Engine Takes all the complexity out of using pencil and paper to figure out the premiums per the Obamacare/ACA rules under CFR §1.36B-3 *
Art Gallagher Employers Guide to COBRA
- #Social Security Disability Benefits Publication # 10029
- SSI Introduction Publication # 5-11000
- More than you ever wanted to know on SSI
Understanding SSI Publication # 17-008 120 pages
- Our webpage on SSI & SSDI Social Security Disability Income.
Medi Cal Contact Information
- Medi Cal Contact Sheet
- [email protected] regarding general Medi-Cal eligibility. If the question contains specific details the county or the district office that handles your case must answer.
- Medi-Cal Member & Provider helpline, at (800) 541-5555.
- California Department of Health Care Services 1-844-253-0883
- [email protected]
- IHSS In Home Supportive Services
- Direct Phone # for Medi Cal 866.613.3777 (Anthem Blue Cross?)
- 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
- Health Consumer Alliance at 1-888-804-3536.
- Disability Rights California at 1-800-776-5746.
- Covered CA Facebook Page
- HICAP – Health Insurance Counseling & Advocacy Program
- CA Health Care Advocates – 1-800-434-0222 Volunteer counselors can help you understand your specific rights and health care options
- Medi Cal Consulting Services
- National Center on Law & Elder Rights - Case Consultation for Professionals
- VITA Volunteers Income Tax Assistance
- Medi Cal - Technical Comprehensive Reference Materials
- Our webpage on education, research & tutoring for a fee
- aging.ca.gov/Medicare_& Medi Cal Counseling
- Elder Care locator
Medi-Cal for All Children program
See our Main Webpage on Medi Cal contact information
Top 5 - 10 causes of Long Term Disability Claims
Our webpage on Disability Payments - Insurance
Child & Related Pages in Dependent Definition section
- CA Mental Health Parity AB 88 (1999)
- Resources – Mental Health
- Blame – Your fault or being scapegoated?
- Co Dependency
- FSP Full Service Partnership
- Lanterman – LPS – Conservatorship
- Laura’s Law – Court Mandated Mental Health Treatment
- Organizing, Hoarding, & Cluttering
Anchors chielfly dependent