Disabled Adult Children may be able to stay on Parent’s Health Plan Indefinitely
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:
(2) 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
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.
“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.
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!
2: 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 Publication 501 – Search for rules on determining support
IRS Worksheet for Determining Support
Parents & CareGivers
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
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- Read the Statute – Policy
- Read the Statute – Policy
- Then when you think you understand it, read it again
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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
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Anchors chielfly dependent