CA Insurance Code §10853
(e) “Dependent” means the spouse or registered domestic partner, or child, of an eligible employee, subject to applicable terms of the health benefit plan covering the employee, and includes dependents of guaranteed association members if the association elects to include dependents under its health coverage at the same time it determines its membership composition pursuant to subdivision (s).
(f) “Eligible employee” means either of the following:
(1) Any permanent employee who is actively engaged on a full-time basis in the conduct of the business of the small employer with a normal workweek of an average of 30 hours per week over the course of a month, in the small employer’s regular place of business, who has met any statutorily authorized applicable waiting period requirements… Legislature.Gov *
See also the Employer Administrative Manual for the relevant Insurance Company!
Individual & Family Policy Definitions
To be eligible for coverage as a Dependent, the individual must meet all eligibility requirements listed above, as well as certain Covered California Dependent eligibility requirements. The individual must:
Be listed on the enrollment form completed by the Subscriber; and
Be the Subscriber’s spouse, Domestic Partner, or be under age 26 and the child of the Subscriber, spouse, or Domestic Partner. [no requirement to be on tax return!]
o For the Subscriber’s spouse to be eligible for this plan, the Subscriber and spouse must not be legally separated.
o For the Subscriber’s Domestic Partner to be eligible for this plan, the Subscriber and Domestic Partner must have a registered domestic partnership.
o “Child” includes a stepchild, newborn, child placed for adoption, child placed in foster care, and child for whom the Subscriber, spouse, or Domestic Partner is the legal guardian. It does not include a grandchild unless the Subscriber, spouse, or Domestic Partner has adopted or is the legal guardian of the grandchild.
o A child age 26 or older can remain enrolled as a Dependent if the child is disabled, incapable of self-support because of a mental or physical disability, and chiefly dependent on the Subscriber for economic support.
The Dependent child’s disability must have begun before the period he or she would become ineligible for coverage due to age.
Blue Shield will send a notice of termination due to loss of eligibility 90 days before the date coverage will end. The Subscriber must inform Covered California of the Dependent’s eligibility for continuation of coverage within 60 days of receipt of this notice in order to continue coverage.
The Subscriber must submit proof of continued eligibility for the Dependent at Blue Shield’s request. Blue Shield may not request this information again for two years after the initial determination. Blue Shield may request this information no more than once a year after that. The Subscriber’s failure to provide this information could result in termination of a Dependent’s coverage. Blue Shield EOC *
Note though that for Covered CA subsidies – it goes by whose on the tax return!!!
College Coverage? CA Health Line
…Group or individual health insurance coverage that provides dependent coverage of children shall continue to make such coverage available for an adult child until the child turns 26 years of age.
College attendance or student status is no longer an issue! ((Obama’s Plan SEC. §2714(a). EXTENSION OF DEPENDENT COVERAGE. FACt Sheet , Blue Cross Specimen Individual Policy * consumer notice * Overage Dependent Quick Guide *Regulations & Guidance
Definition of Dependent
Internal Revenue Code IRC §152
a)”dependent” means any of the following individuals (click here for list) over half of whose support, for the calendar year in which the taxable year of the taxpayer begins, was received from the taxpayer (or is treated under subsection (c) or (e) as received from the taxpayer): IRS Publication 501
Our Site on 1040 including instructions
Insurer’s must notify you, when you lose dependent status (AB 910 2007)
At age 26 check out:
- Get FREE CA Quotes under Health Care Reform
- COBRA & Cal COBRA
- Lifetime Coverage for disabled child over 26
What about adult children under 26?
For Covered CA Subsidies?
Adult child up to age 26 are eligible for Coverage through their parents employers plan. However if they are paying their own taxes, they are not anyone’s tax dependent, they do not count towards household income, – MAGI. Then the adult children could qualify for their own coverage in Covered CA.
In some cases, it might be an idea to exclude dependents from coverage on a group plan, so that the spouse and children can qualify for Covered CA subsidies. Thus avoiding the the Family Glitch?
Be sure to check the EOC Evidence of Coverage of YOUR policy!
Here’s excerpts of a sample Individual ACA Health Reform Compliant Policy:
Newborns are covered during the first thirty-one (31) days from birth and Adopted Children are covered during the first thirty-one (31) days from the date the Subscriber, enrolled spouse, or enrolled Domestic Partner is granted the right to control health care for an Adopted Child. Refer to the part YOUR ELIGIBILITY for additional information about coverage of Newborns and Adopted Children Specimen Policy Page 20
Newborn and Adopted Child Coverage Newborn and adopted child(ren) of the Subscriber or the Subscriber’s spouse will be covered for an initial period of sixty (60) days from the date of birth or adoption. Coverage for Newborn and adopted child(ren) will continue beyond the sixty (60) days, provided the Subscriber submits through us a form to add the child under the Subscriber’s Agreement. The form must be submitted along with the additional Premium, if applicable, within sixty (60) days after the birth of the child. Failure to notify us and pay any applicable Premium during this sixty (60) day period will result in no coverage for the Newborn or Adopted Child beyond the first sixty (60) days Specimen Policy Page 26
Newborn is a recently born infant within thirty-one (31) days of birth. Specimen Policy Page 168 *
As long as you enroll your newborn within 30 days of birth, coverage should be effective as of your baby’s birth date, and your baby cannot be subject to a preexisting condition exclusion.
Remember, you should enroll your baby within 30 days of the date of birth. DOL.Gov
See rules for Special Enrollment for Individual Plans.
Why was I billed for my newborn’s charges?
No insurance will add your newborn automatically. It is your responsibility to inform your insurance company to add your newborn baby. Most insurance companies will give you 30 days after the arrival of your newborn to add them to your coverage. However, not all plans will retro your coverage back to the birth. Always check with your insurance company for their requirements. sjmedicalgroup.com
Forum says the rules above stand… just because insurance company gave a month of coverage, no obligation to extend period to add child.
- Specimen Health Reform Individual Platinum Policy – Eligible Dependents Page 25
- CMS FAQ’s
- Regulations & Guidance
- California Insurance Company Forms & Applications
- Anthem Blue Cross 9/1/2010 Bulletin
- UHC Group Policy Extract
- HealthCare.Gov White House.Gov Affordable Health Care Act YouTube Channel
- Right of Non Custodial Parent to Obtain Medical Information (Family Law Code 3751.5)
- Our Marked Up Copy of Federal Register
- CA enacted SB 1088 2010 Price Insurance Code 10277 to require Insurers to conform with PPACA (Obama’s Plan)
- Federal Regulations – Student Health Plans
- Blue Cross Small Group Administrative Manual
- Loss Ratio is higher for kids on parent’s plan vs those who have their own coverage Washington Post
- Staying on Health Plan if Disabled beyond age 26
- Employer enforcement of exclusion for dependents who are eligible for their own employer-sponsored coverage
- The health care reform law allows grandfathered group health plans to exclude coverage for young adult dependents who are eligible for their own employer-sponsored coverage. While we aren’t making this exclusion standard, 100+ grandfathered groups can choose to have the exclusion. If a group chooses to exclude coverage for dependents who are eligible for their own employer-sponsored coverage, we will add the exclusion to the group’s certificate language. However, we will not enforce the exclusion on behalf of the group. The employer will need to develop a method that suits its particular needs, as well as materials that support the enforcement method (such as an affidavit for employees to verify that their covered dependents are not eligible for their own coverage). (Blue Cross 12/3/2010 Bulletin)
- Covered CA problems with implementing the law.
- Blue Cross FAQ’s 4/30/2010
- LA Times 4/4/2010 Article
- One time Open Enrollment November 2010
- Blue Cross Anthem Open Enrollment November for January 1 Effective Date Application – Change Form
- Commercial health plans and insurers are prohibited from terminating coverage for full-time dependent students over 18 during a break in the school calendar or a medically necessary academic leave of absence.
- Coverage continues for up to one year or until coverage is scheduled to terminate under the plan’s terms and conditions, whichever comes first.
- Documentation of the medical necessity must be submitted to the Insurance Company if the health plan certifies the students for coverage. (kp.org/HR2851) (SB 1168)
- Dependent Children can now be covered to Age 26 detailed information on SteveShorr.com
Family – Income Tax MAGI
Cal Pers drops 9k dependents as they don’t meet the definition californiahealthline.org
- Health Care Reform…. Excerpt from Wikipedia Due to the new regulations of guaranteed issue, and allowing children to be included on their parents’ plans until age 26, several insurance companies announced that they would stop issuing new child-only policies. However, because children would now be covered by their parents’ plans, the Census Bureau found that the number of uninsured 19- to 25-year-olds had declined by 1.6% or 393,000 people by 2011. Starting January 1, 2014, state health insurance exchanges will be required to offer a child-only coverage option, and Medicaid eligibility will be made available to 16 million individuals with incomes below 133% of the federal poverty level.
- When your child/stepchild gets married or turns 23 (whichever comes first), the child is no longer considered your dependent.
- There is one exception: when your child turns 23 but is incapable of self-support because of a physical or mental disability that has existed from before the age of 23. In this case, the child may remain a dependent until the incapacity ends.