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Employee’s guide to COBRA –
Department of Labor
*********
Art Gallagher Consulting Guide
COBRA Continuation Coverage?
Who Is Entitled
COBRA Rights and Responsibilities:
Notice and Election Procedures
Benefits
Duration
Summary of Qualifying Events,
Qualified Beneficiaries
Paying for it
Our Webpage on COBRA * Cal COBRA
Get Individual Guaranteed Issue ACA/Obamacare Quotes - Subsidies if you make less than 600% of Federal Poverty Level!
No Pre X Clause!
No wait for Open Enrollment as you get Special Enrollment when you lose COBRA or your Employer Group Plan!
How long can a disabled child stay on parents 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:
(1) Incapable of self-sustaining employment by reason of a physically or mentally disabling injury, [AB 88] illness, or condition.
(2) Chiefly dependent upon the policyholder or subscriber for support and maintenance. Wikipedia Child Support – Maintenance * 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.
What does chiefly dependent mean?
“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.
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!
2: maintaining or able to maintain itself once commenced – a self-sustaining nuclear reaction Webster *
IRC §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 *
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
Publication 501
Get FREE Instant California Quotes - Including Tax Subsidy Calculation - Guaranteed Issue - No Pre-X Claus
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
Links & Resources
Mental Health Benefits are an essential benefit under Health Care Reform.
Dental Coverage can be purchased here.
Dual Coverage – Which Insurance Company pays first? Medi-Cal, SSI, SSDI?
tacanow.org Autism Website
Set up a phone, skype or face to face consultation
Tools to help you figure out how much you should get
Video on how much coverage for death protection you need
Where do I get the forms to document that my disabled son who turns 26 in a month so that I can keep him covered on my United healthcare insurance. I live in Florida no one seems to know.
Check your EOC Evidence of Coverage – Here’s our sample…
Customer Service
For questions about services, providers, Benefits, how to use this Plan, or concerns regarding the quality of care or access to care, contact … Customer Service Department. Customer Service can answer many questions over the telephone. Contact Information is provided on the last page of this Evidence of Coverage.
https://www.uhc.com/contact-us
Try logging into
myuhc.com
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
Do you support him? Can he get a job? Can you get a doctors statement that he can’t work?
He can always get COBRA for 18 months https://employers.healthreformquotes.com/cobra/ if it’s an employer group plan.
Cal Cobra if a CA employer and you’re in CA for another 18 months https://employers.healthreformquotes.com/cobra/california-cal-cobra/
He can get ACA obamacare with no pre-existing clause. Click here for CA Quotes. http://www.quotit.net/eproIFP/webPages/infoEntry/InfoEntryZip.asp?license_no=0596610
Try these websites for help so that your son can find employment:
https://www.listenclear.com/
https://www.nad.org/
https://www.asha.org/public/hearing/Support-Services-for-Adults/
http://www.deaflinx.com/Services/gov.html
https://www3.gallaudet.edu/clerc-center/info-to-go/national-resources-and-directories/organizations.html
https://www.hearingloss.org/hearing-help/financial-assistance/
I have a child that has Autism and is considered disabled. He will turn 26 at the end of the year can he still stay on my United health care insurance under my employer
See our page about reading the law 3 times and then when you think you understand it, read it again https://healthlaw.healthreformquotes.com/plain-meaning-rule/
See our page on Autism https://mentalhealth.healthreformquotes.com/mental-health/resources-mental-health/autism/ If you have anything to add about Autism, please place it in comments. You don’t have to leave your name.
Is your son disabled according to the definition on the beginning of this page?
See Q & A right above this one.
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.
Is there a retirement health plan for your Dad to stay on at his work?
If all else fails, there is COBRA for 18 months.
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!
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.
Do you get Medicare immediately or after two years?
I don’t know about opting out of CCC… I’m only licensed in CA. Here’s how to opt out of Cal Medi Connect https://medimedi.healthreformquotes.com/medi-medi/hmo-plans-available-in-cal-medi-connect/opt-out-of-cal-medi-connect/
Here’s some Q & A on that… https://medimedi.healthreformquotes.com/medi-medi/hmo-plans-available-in-cal-medi-connect/opt-out-of-cal-medi-connect/#comment-25
It’s one thing to simply not use Medi Cal, Medicaid, quite another to formally drop out of the program.
When you qualify for Medicare, that would make you eligible for Medi Gap, although the under 65 rates are higher than for a 65 year old. https://medicare.healthreformquotes.com/medi-gap-supplements/
You could also get a Medicare Advantage Plan https://medicare.healthreformquotes.com/medicare-advantage-plans/
Here’s our website on Medi Medi Medi Cal – Medicaid and Medicare together https://medimedi.healthreformquotes.com/medi-medi-introduction-medicare-medi-cal-together/
It’s confusing and complicated. I haven’t found many people that I could trust and are knowledgeable on all the rules…
CCC?
California has a similar program https://medimedi.healthreformquotes.com/medi-medi/
Here’s the website for the Virgina Program
https://www.cccplusva.com/choose/if-you-qualify-for-or-get-medicare
https://www.cccplusva.com/choose/tips-for-choosing-health-plan
Provider Search
https://ssa-vaeb.maximus.com/VASelfService/resources/portal/index.html#P/public/provider_search
I’m covered under the state of Texas employee plan Blue Cross Blue Shield
where can I find the forms and procedures to keep my disabled child on the program now that he has turned 26?
Here is the forms and procedures on the state of Texas website
https://ers.texas.gov/Active-Employees/Life-Changes/Children/Disabled-Dependent-Child
is there anything that I should add?
can you link me to the laws on this so I will know what I’m talking about?
also will it affect him because he’s not on Social Security disability?
and because addiction?
I don’t imagine that you would need to do anything, other than comply with the request to fill out an application for the coverage.
https://ers.texas.gov/PDFs/Forms/Request_Renew_Health_Coverage_Disabled_Dependent-Child-2654.pdf
Texas Law?
http://www.texas-statutes.com/insurance-code/chapter-1551-texas-employees-group-benefits-act
https://capitol.texas.gov/tlodocs/83R/billtext/html/HB02155F.HTM
(3) child of any age who the board of trustees
determines lives with or has the child’s care provided by the
individual on a regular basis if[:
[(A)] the child is mentally or physically
incapacitated to the extent that the child is dependent on the
individual for care or support, as determined by the board of
trustees;
https://www.tdi.texas.gov/pubs/consumer/cb039.html
https://www.navigatelifetexas.org/en/insurance-financial-help/health-care-benefit-programs-insurance-for-children-with-disabilities
When Your Child Turns 26 Years Old
Some adult children who “age out” of their parents’ health insurance plans can still be covered. If your child’s mental health or physical disability prevents them from working and living independently, you might be able to keep them on your policy by submitting proof of their disability to your insurance. Talk to your insurance company to learn more.
Reads pretty much the same as CA law, that I’ve cited above. If you want more information, contact an attorney licensed in TX.
I don’t see any requirement to be on SSDI and he may not qualify as he never worked. You might be talking about SSI?
https://socialsecurity.healthreformquotes.com/disability/
https://socialsecurity.healthreformquotes.com/ssi/
I don’t see any mention of addiction. Just apply and I don’t see any need to make a federal case of this.
Your son isn’t alone having bi polar and an addiction problem
https://www.dualdiagnosis.org/bipolar-disorder-and-addiction/
I don’t work for the State of TX, I can’t answer your questions. I can only read the law and give you the actual law. I don’t have a crystal ball.
https://healthlaw.healthreformquotes.com/plain-meaning-rule/
Thank you
Rather than read the law… How about the Evidence of Coverage, which in CA and probably TX is required to be in plain English. Check page 127 of your EOC. https://ers.texas.gov/PDFs/2018-HealthSelect-of-Texas-In-Area-MBPD.pdf#page=134
My son is 28 years old and is severely mentally ill. He has Bipolar and has a substance abuse addiction
We are a retired military family and have Tricare now Humana.
I wasn’t able to provide the right paper work. Last time I sent all the documents they asked for and still I keep getting need more evidence I can’t figure out.
If you want to send us your paperwork privately, we can take a look at it and let you know how long it might take us to help you comply with their rules. You can then make an offer to compensate us for our time and what you expect for that payment. If it’s something simple and we can post anonymously to our website, we would likely do it at no charge as that’s how we build our website.
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
Do you meet the definition of disabled above? That is, you can’t hold a job and are chiefly dependent on your parents for support?
Check with CIGNA’s member services, your Insurance Agent, your parents employer’s HR department and get the forms to certify (Sample from Oscar Insurance) your disability.
If you don’t meet the definition of disability, you can get special enrollment into ACA/Obamacare (get quotes) as you’ve lost coverage.
If you are not dependent on your parents… you may qualify for Medicaid either under MAGI Income Rules or aged & disabled. If you are getting SSI you automatically qualify for Medicaid.
I recently did a fundraiser for my friends disabled child and raised $13,000.
I need to know if I write a check for the proceeds to him, will he lose his coverage?
See our webpage above and review the definition of “chiefly dependent”
See also the IRS worksheet above
Please note the court ruled that there is no exact definition – so I can’t give you one
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
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.
How do we place our 27 year old daughter back on the Insurance to that it will pay for assisted living?
1st get the forms from your Insurance Company.
Verify that you qualify.
Is your daughter chiefly dependent upon you?
Will your coverage pay for assisted living?
Is that a medical treatment?
Is it in the Principal Benefits and Coverages (Covered Services) section of your coverage?
Is assisted living medically necessary?
Sample Evidence of Coverage
https://healthlaw.healthreformquotes.com/medical-necessity/
Does she need assisted living or Board & Care?
Does she have Medi Cal, Medicaid?
Medicare?
Is she on SSI?
Check these links:
https://life.healthreformquotes.com/long-term-care/nursing-homes/assisted-living/
https://life.healthreformquotes.com/long-term-care/nursing-homes/home-health-care-finding/
https://life.healthreformquotes.com/long-term-care/cant-afford-premiums-or-not-medically-qualified/low-income-assets-assistance-alternatives/medi-cal-qualification-nursing-home/alw-california-assisted-living-waiver/
https://life.healthreformquotes.com/long-term-care/
https://life.healthreformquotes.com/long-term-care/cant-afford-premiums-or-not-medically-qualified/low-income-assets-assistance-alternatives/medi-cal-qualification-nursing-home/medi-cal-nursing-home/
https://socialsecurity.healthreformquotes.com/ssi/
https://medi-cal.healthreformquotes.com/eligibility/aged-and-disabled-federal-poverty-level-program/
https://life.healthreformquotes.com/long-term-care/cant-afford-premiums-or-not-medically-qualified/low-income-assets-assistance-alternatives/medi-cal-qualification-nursing-home/
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.
See our Medicare Part B page and Employer Plans.
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
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/
My son used to be on my health insurance via my employer and was removed when he turned 26 yrs old, he is now 29 and disabled.
Would I be able to put him back on my health insurance with my employer and have Medicaid as a secondary insurance for him?
I am in the state of Kansas.
I doubt it as he wasn’t disabled before age 26. Please read the law cited above 3 times and when you think you understand it, read it again. If you have more questions, put them here.
ACA/Obamacare is guaranteed issue. You can have an individual policy in addition to Medicaid – Medi-Cal (California)
In CA, you can get quotes here.
It wouldn’t hurt to fill out the forms to ask, but I don’t see that your employers health plan is mandated to take it. I only do CA and National Health Laws, if Kansas has something that might help you, you would have to check with the Department of Insurance there or see if you can find a top notch agent there. Here’s the NAHU Agent Finder.
I have a 36 year old who is on SSI disability and want to know if I can add him to my policy with Harvard Pilgrim Health Care in Mass.
I’m not familiar with the laws and Insurance Company rules in Mass. I don’t know of a federal law requiring disabled children be covered under the parents policy. There is always guaranteed issue ACA/Obamacare. Click here for quotes.
Here’s the page on Pilgrim’s website showing the SOB SBC for their plans. Unfortunately, what you need is the EOC.
Here’s their contact page https://www.harvardpilgrim.org/public/contact-us
I searched more and found this EOC. I found this, that sounds just like CA law above, so maybe there is a federal law on it! autismspeaks.org states that nearly ALL states allow disabled dependents to remain on their parents plan. 30 states use the one similar to CA, can’t hold a job and chiefly dependent on parents for support.
Page 56
2. Dependent Eligibility
4) A child (including an adopted child) of the Subscriber or spouse of the Subscriber, age 26 years or older who meets each of the following requirements:
(a) is currently Disabled;
(b) was Disabled on his or her 26th birthday;
(c) lives either with the Subscriber or spouse or in a licensed institution; and
(d) remains financially dependent on the Subscriber. The term “Disabled” means unable to engage in any substantial gainful activity by reason of a specific medically determinable physical or mental impairment which can be expected to last, or has lasted, for at least 12 months or result in death.
If your child has not been covered under your plan since prior to age 26, I don’t think so. Check with Pilgrim. Here’s a sample form from Aetna.
The form is called “Request for Continuation of Coverage for Disabled Child”
Please be sure to read your actual forms THREE times. Then when you think you understand it, read it again.
What plan is your child covered by now?
Medicaid?
Medicaid and other coverage issues, coordination of benefits?
Guide to Health Insurance in Mass.
See also
https://tacanow.org/family-resources/dependent-disabled-adults-continuation-of-private-health-care-coverage/
https://nationaldisabilitynavigator.org/2015/04/16/enrolling-an-adult-dependent-with-a-disability/
I’m looking for information on adding a dependent and disabled child to a health insurance plan.
The child is over 26 yrs old and disabled.
Did you want to add the child to your current plan or did you want to get a new plan for the child?
Is your child currently on your plan?
When did he become disabled?
Here’s a link to get quotes for an individual plan.
Has your current plan notified you that your child may be losing coverage?
Please review the page above.
I have a 26+ year old child deemed incapable of self support and receiving social security disability. I just started a new job and have been told she is NOT eligible for health care coverage.
xxx healthcare is claiming they only have to extend coverage to those children who were in their insurance plans prior to age 26 regardless of my being a new employee.
Do you mean the Insurance Company is saying they won’t transfer the benefit over, from your prior employer, when you say:
who were in their insurance plans
Has your child been on your prior coverage?
See our page where we cited Insurance Code 10277d
(d) 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.
The new plan or insurer may request information about the dependent child initially and not more frequently than annually thereafter to determine if the child continues to satisfy the criteria
My son has had SSDI for 2 years and now has Medicare. He may also qualify for Medi-Cal (Medicaid)
Would having Government or other coverage disqualify him from remaining on an individual or employer group plan from his parents?
I don’t see anything in the law (which we can only point out to you, we are not attorney’s and can’t interpret or advise you) or Sample EOC – Evidence of Coverage that says that he would not qualify for having other coverage.
Just review our pages on dual coverage…
https://medicare.healthreformquotes.com/part-hospital-part-b-md-visits/dental/accident/medicare-dual-coverage/
https://healthlaw.healthreformquotes.com/dual-coverage/
https://medi-cal.healthreformquotes.com/faqs/dual-coverage/
My Question is with a RETIRED California employee with a (long-term) disabled child, now age 29.
How long can such disabled child stay on the (large employer – quasi-govt facility) company plan?
Our SAMPLE Evidence of Coverage on page b 54 provides that an employee can be covered after retirement in Section 2 d:
d) When the Member is retired and age 65 years or older.
Enrolled disabled Dependent children who would normally lose their eligibility under this health plan solely because of age, may be eligible for coverage if they continue to meet the definition of Dependent. See the Definitions section. Page B-57
Definitions Section
Employee — an individual who meets the eligibility requirements set forth in the Group Health Service Contract between Blue Shield and the Employer.
See Page B 71 for the rules for dependents. Same as above.
To know for certain, we need to see YOUR Evidence of Coverage and Group Service Agreement – Contract, otherwise is a SWAG answer.
COBRA would be available, Heaven forbid if the employee passes away. There is also guaranteed issue ObamaCare. Get Quotes in CA. If the child qualifies, there is Medi-Cal, Medicaid.
If my daughter who has documentation of her disability and its eligible for my health insurance and vision insurance will she also be able to get dental insurance even though the dental company denied the claims saying she was too old, but yet I pay for her health insurance, dental and vision?
If nothing else you can select an individual dental plan for your daughter here http://www.dentalforeveryone.com/default.aspx?id=03355-00000
Dental coverage is not protected under the law, it’s not hospital, medical or surgical.
I have the same problem. My employer took my 26 year old special needs son off the dental plan with no notice or anything.
What if disabled child lives with father, and pays majority of support, but medical insurance is paid by mother through employer.
Child will be 26 next March.
Each parent meets only one requirement.
Can child still be covered by mother after age 26?
I believe so. Both of you are still the parents. The child is still dependent on his/her parent (s)
I’m out of country. If you haven’t resolved this with your employer’s insurance company, email me mid May
What happens when the parents no longer work for an employer, or they pass away, whose coverage the disabled child – Bi Polar, is covered by?
I like the coverage provided by Shell Oil and don’t want anything else, it would be inferior coverage.
There would be COBRA for 18 or Cal COBRA for a total of 36 months.
You can also get OBAMACARE ACA as you would have a special enrollment when you lose coverage. Get quotes here. Mental Health is an essential benefit under the ACA. Even if the ACA gets overturned, CA has numerous laws mandating Mental Health Coverage. So did the Federal Government.
Otherwise, I guess you would lose coverage… if your parents pass away, you would not be chiefly dependent on them.
If you’re disabled, how about SSI, SSDI, Medi-Cal and Medicare? Social Security Survivor Benefits?
What happens if a disabled dependent over 26 gets married? Does the parents’ coverage for that person end?
I can’t seem to find an answer to this. (California resident).
Good question. Is the disabled person still “chiefly dependent” on the policy holder, see above? If you do lose coverage, that would give you a special enrollment into ACA – get quotes here.
What Insurance Company are we talking about? I can then pull the forms and proofs for that specific company.
While this page is very popular 189 hits in the last 30 days, no one is buying Insurance from me and thus I haven’t kept up posting the revised forms. I’m happy to when asked.
Yes, she is “chiefly dependent” on her parents’ insurance for lifelong medical care.
The policy holder is Anthem Blue Shield/blue Cross.
She also received SSI benefits.
Please read again, at least 3 times, what chiefly dependent means. It doesn’t mean how much she needs or uses the insurance, but if her parents are supporting & maintenance for her. Please review the footnotes above that I’ve just added.
Now that she’s married, is her husband supporting and providing maintenance for her?
If she has SSI that provides around $1,000/month for support. Are her parents providing more than that? In addition, SSI automatically gives her Medi-Cal coverage.
In CA telling me Blue Cross – Blue Shield means nothing. They are two separate companies.
Please send a copy of her ID card. Then I will know and can get further details. I will not post any PHI – Protected Health Information. If I do post the ID card, I will blot that out.
Thanks for the ID card. The plan your friend has is not one that I’m an authorized agent for. Please have her or her parents log into their “member portal” and then you can review the actual EOC full policy and the forms that BC/BS requires to prove disability. Also you can check the definition of dependent and from what I can tell in general, being married doesn’t disqualify a child. I’m concerned about “chiefly dependent.” Please review the page above again, as I just updated it.
My daughter became disabled and unable to support herself at age 27.
She had already been terminated from my company plan (a CA plan) at age 26.
Might there be any possible way I can get her back on my CA Employer Coverage?
Near as I can tell, the law lets coverage end at age 26. Here’s clarification in Blue Shield’s Group plan
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.
I don’t see a way to get her on your bosses coverage. She wasn’t disabled prior to age 26.
How about an Individual Plan? Free Quotes
Cal or COBRA?
SSI?
Medi-Cal
SSDI
Medicare?
Doesn’t the obama care plan (Covered CA) depend on your income?
I have a niece (>27yo) who is also low income and without a job and covered CA only allowed her to get a medi-Cal policy.
We are hoping for fewer exclusions and more coverage choices
ACA – Obama Care – Covered CA only asks for your income if you want subsidies, tax credits to pay for your premiums. If you use our quote engine, you can get quotes both with and without subsidies.
Here’s the income chart to see what enhanced silver level you might get, Medi-Cal, subsidies, etc. Again, if you don’t want subsidies, don’t ask for them. No one can force you to take Medi-Cal.
Here’s what I have on the benefits for Medi-Cal. I don’t get paid to do Medi-Cal. If you find something about benefits that I don’t have, please post it to help your fellow website visitors.
All new insurance plans, must have these 10 essential benefits. ACA wanted to standardize shopping around for plans, so the only real choices are doctor lists, metal levels and insurance company service – reputation.
Do we have a special enrollment period for your daughter to get coverage now? Otherwise we have to wait till 11.1.2017 for Open Enrollment to get a plan for 1.1.2018.
Do you have a sample letter of certification that I might provide to my physican? My father is employed by the UC system and I live in New Orleans so my physician may not be accustomed to preparing the certification letter.
We will answer your question on this new page for the University of CA System
Hi,
I understand that CA law allows your incapacitated or disabled child over 26 to remain on the parents group or individual policy, indefinitely. Where could I find out if my son, a Massachusetts resident, would be covered?
Thanks SO much.
Sue O
The first thing to check is your actual evidence of coverage – full policy. Here’s a specimen.
It doesn’t look like Massachusetts has this feature. NCSL.Org
Mass. Gen. Laws Ann. Ch. 175 § 108 allows dependents to stay on their parent’s coverage for two years past the age of dependency or until age 26, whichever occurs first, or without regard to age if they are incapable of self-sustaining employment due to disability.
Young adults ages 19-26 are eligible for lower-cost insurance coverage, tailored to meet their needs, offered through the Commonwealth Health Insurance Connector. Reform summary and fact sheet, PowerPoint presentation.
ACA Obamacare is guarantee issue. Why not just get him his own policy?
Is your son on your policy now?
It appears to be optional in your state, not mandatory.
If your adult ‘child’ is mentally or physically incapable of earning his or her own living, the
family’s private health insurance may offer Adult Disabled Dependent Coverage. You need to
contact your insurance company to find out: 1) if this is an option, 2) the documentation they
require from your child’s physicians, and 3) if there is an extra premium. fcsn.org
See page 26 of a CA Individual Specimen Policy for the rules to qualify and availability.
With Guaranteed Issue under ACA I don’t think the feature is that meaningful. Is there something I’m missing? It’s not like there a a family rate and no charge for the child, right?
In the past, we were able to enroll disabled dependents with proof of prior coverage and documentation of disability, but Blue Shield says that they will only cover disabled dependent children already enrolled on our group plan that happen to age out.
….. ***We will answer your question here https://employers.healthreformquotes.com/ab-1083/employer-definition/employee-definition/dependent-definition/disabled-children/rules-insurance-companies-coverage-disabled-children/transfer-rules/