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Proofs Required for Disabled Child
Proofs Required for Disabled Child – If you have other questions – Please post in the ask a question area below

How long can a disabled child
stay on parents health insurance?

CA law allows your incapacitated 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. CA Insurance Code § 10278    §10277    for Group Policies Self Insurance Plans §10124  10118

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. Learn More ⇒  Odlin v. U.S.

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.

Click here for Guaranteed Issue Health Insurance – ACA ObamaCAre
No Medical Questions asked – No Pre-X
Quotes in CA or Nation Wide.

In Covered CA, (we are authorized agents) there may be issues with subsidies – MAGI Income.

Email us your questions.

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!

Links & Resources

What if employer is not subject to CA Law?

Mental Health Benefits are an essential benefit under Health Care Reform.  New Final Rules Regulations were JUST issued…

Thus, dental coverage is not included.  Dental does not ask about health, so Dental Coverage can be purchased here.

So, age 26 is not relevant, as long as the child meets the above definition and requirements of being disabled.

Dual Coverage – Which Insurance Company pays first?  Medi-Cal, SSI, SSDI?

 

tacanow.org Autism Website – Their research & Ideas

New York NYSHIP Law  findlaw.com/ny code 4305

 

FAQ’s 

Email us with your specific situation if in CA and we can send you an answer.

Disabled Dependent Child

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Is an over-age disabled dependent eligible to continue coverage through this new insurance carrier if they were covered under their parents’ previous policy?
Is an over-age disabled dependent eligible to continue coverage through this new insurance carrier if they were not covered under their parents’ previous policy?
If the disabled child is eligible to continue coverage, what documentation will be required?

Proofs Required for Disabled Child
Proofs Required for Disabled Child – If you have other questions – Please post in the ask a question area below
How often will the disabled dependent child be required to re-certify this disability?

 

 

Most of what the video says is RIGHT, not grandfathering though. Let me know if you find a video more on point

Related Pages in Dependent Definition section

9 comments on “Disabled Children – over 26

  1. 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.

  2. 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.

  3. 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?

  4. 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 on our new page.

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