🔵 START HERE – What Are You Trying To Do?

👉 Keep my child on my health plan (under age 26 – California law)
👉 Most plans allow coverage to age 26 regardless of disability – Covered CA subsidies go by household income… Does the child file his own taxes?

👉 My child is over age 26 and disabled — what are the options?

👉 Learn about DAC Disabled Adult Child, Medicare, and Medi-Cal

👉California right to keep child under parents policy – Scroll down and See the  law below

👉 Lower Medi-Cal Share of Cost (California only)

👉 Strategies to reduce or eliminate share of cost

👉 [Working Disabled Program →]

🟩 CALIFORNIA LAW – CONTINUED COVERAGE FOR DISABLED DEPENDENTS

California law requires  health plans to continue coverage beyond age 26 for a disabled dependent child.

✔ To qualify, the child must:

• Be incapable of self-sustaining employment due to a physical or mental disability

• Be chiefly dependent on the parent for support

✔ Coverage continues:

• Even after age 26

• As long as disability and dependency requirements are met

📖 Legal Authority

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 when the child reaches  age 26 under 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}

⚠️ Important Exception

• What about #Selfb Insured Plans?

  • Some self-funded employer plans (ERISA plans) may not be subject to California insurance mandates. Always verify with your plan administrator.
  • Check out our webpage on  evidence of coverage – EOC say?
  • ADA The Americans with Disabilities Act in a Health Care Context  NCBI.NLM.NIH.gov
  • CA Department of Insurance does not regulate Self Insured Plans Insurance.CA.Gov

👉 Always confirm with your HR department or plan administrator.

In practice, most denials happen because the documentation wasn’t submitted—not because the child doesn’t qualify. Submit the request first, then appeal if needed.

FAQ’s on CA  Law 

• • Before asking us about this law or if you qualify.
    • Please read the law above THREE times and the definition of chiefly dependent  below
    • Ask your employer’s HR department for the relevant forms and a copy of your evidence of coverage
      • For Individual & Family, ask your current broker or Insurance Company to send you the Disabled Dependent Certification and Evidence of Coverage.
  • • • What about getting disability income protection for the parents & caretakers?
      • What about when employee retires?
      • Dual Coverage – Medi Cal?
      • I don’t understand all this and I need private tutoring, education or research, can we arrange that?
    • How to get documents from the US Department of Labor  – ERISAReview the FAQ’sMust the Insurance Company give me notice that they won’t be coverage my child after age 26?
    • • Yes, see CA Insurance Code 10277 3 B

DON’T CONFUSE THESE TWO RULES

🔄 WHAT HAPPENS AT AGE 26?

At age 26, most health plans will no longer allow a child to remain on a parent’s policy.

Families then ask:

• What coverage options are available?

• Does disability change anything?

• Can coverage continue another way?

🧠 THIS IS WHERE DAC MAY APPLY

If the disability began before age 22, the individual may qualify for:

• Social Security Disabled Adult Child (DAC) benefits

  • Medicare (after eligibility period)

• Medi-Cal (California)

📊 SIMPLE FLOW (HOW THIS ALL CONNECTS)

Under age 26
↓
Covered under parent’s or employer health plan (CA law)
↓
Turns age 26
↓
Coverage ends (in most cases)

If disabled, see law above
↓
If disabled before age 22

↓
May be Eligible for DAC benefits
↓
May qualify for Medicare

↓
May qualify for Medi-Cal
↓
May have Share of Cost (California) depending on income
↓
👉 Can be reduced with planning strategies

🟡 CALIFORNIA RESIDENTS – IMPORTANT PLANNING OPPORTUNITY

Many individuals transitioning off a parent’s plan will qualify for Medi-Cal.

This can result in:

• A monthly Share of Cost  depending on income

• Out-of-pocket medical expenses before coverage begins

👉 This is where planning matters

You may be able to:

• Reduce or eliminate share of cost

• Coordinate Medicare and Medi-Cal

• Use strategies such as dental coverage

👉 [Step-by-Step: Lower Your Share of Cost →]
👉 [Working Disabled Program (Keep Income + Medi-Cal) →]
👉 [Dental Strategy to Offset Share of Cost →]

🏥 HEALTH COVERAGE OPTIONS AFTER AGE 26

Once coverage under a parent’s plan ends, options may include:

• Medicare (if eligible through DAC)

• Medi-Cal

• Individual health insurance (Covered California or direct)

❓ FREQUENTLY ASKED QUESTIONS

Can a disabled child stay on a parent’s health plan after age 26 in California?

Yes—if the child meets California’s definition of a disabled dependent.

California law requires many employer and individual health plans to continue coverage beyond age 26 for a dependent child who is:

• Incapable of self-sustaining employment due to a physical or mental disability, and

• Dependent on the parent for support

Coverage may continue as long as the disability and dependency requirements are met.

Does the disability have to begin before age 22 to stay on the health plan?

No.

The “age 22” rule applies to Social Security Disabled Adult Child (DAC) benefits, not to staying on a parent’s health plan under California law.

Do all employer plans have to allow disabled dependents over age 26?

Most California-regulated plans do—but there can be exceptions.

• Fully insured plans in California are generally required to follow state law

• Some self-funded (ERISA) employer plans may follow federal rules instead

👉 Always confirm with your HR department or plan administrator

What documentation is required?

Most plans will require proof that the child:

• Is disabled (medical documentation or Social Security determination), and

• Is financially dependent on the parent

Requirements vary by plan, so check with your employer. or your EOC evidence of coverage.

What is a Disabled Adult Child (DAC)?

A Social Security classification for individuals whose disability began before age 22 and who qualify for benefits based on a parent’s work record.

What happens if coverage eventually ends or is not available?

The individual may qualify for:

• Medicare (through DAC)

• Medi-Cal (California)

  • BenefitsCal.com 
  • 

• Individual health coverage  Get Instant Quote

👉 [Learn how to reduce Medi-Cal Share of Cost → if you have high income]

CALIFORNIA LAW – DEPENDENT COVERAGE TO AGE 26

In California, children can generally remain on a parent’s employer or individual health plan until age 26, regardless of disability, student status, or financial dependency.

This rule applies to:

• Employer group health plans

• Individual and family plans

• Our webpage on dependent definition 

📌 Key Point:

The Social Security age 22 disability rule does NOT apply to staying on a health plan in California.

SSI – Supplemental Security Benefits – Automatic Medi Cal – SSDI

• DAC Disabled Adult Child – Keep Medi Cal – Retirement – Pickle

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!

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

Get the EOC, Evidence of coverage FULL Policy  from your own Insurance Company, HR, # on back of your ID Card  and see what it says!   Visit our webpage on  EOC, Plain Language, etc. 

FAQ’s 

Would an immediate annuity help your situation?

Benefits of Retirement Planning & Effect on MAGI Income

• Annuities & MAGI Income Taxation Exemption