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

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How long can a disabled child stay on parents insurance?

CA law allows your incapacitated or disabled child over 26 to remain on the parents group or individual policy, 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 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 – No Medical Questions asked
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.

Proof of Disability Forms

Langford University

Blue Shield

Cal Choice

Blue Cross Group Employer Administrative Manual Page 16

Aetna Forms

  • Handicapped Child Continuation of Medical Coverage
  • Handicapped Child Attending Physical Statement  Indicates Adobe Reader File Format

Email us for CA Proof of Disability Forms, if you can’t get them from your HR Department or Individual Agent

Considering that everything is guaranteed issue, with no Pre X starting 1.1.2014, I don’t think this page will be relevant anymore.

Client  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.

Insurance Companies must give notice before terminating coverage AB 910)

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

Legal Obligation to financially support adult disabled child?

Dual Coverage – Which Insurance Company pays first?

Is your child – Medicare Eligible    Social Security Disability SSI – SSDI?    Medicare Advantage Plans    Medi Gap

tacanow.org Autism Website – Their research & Ideas

New York NYSHIP Law  findlaw.com/ny code 4305

ACA & Children with Special Health Care Needs

Our webpage on Social Security Disabiliy, SSDI, SSI & Publications  – Benefits for Children with Disabilities # 10026

Agent ONLY Resources

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

Disabled Dependent Child 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?
How often will the disabled dependent child be required to re-certify this disability?

Legal Codes – Excerpts of Actual Law

Government Code § 9373Disability,” “disabled”  or “incapacitated” means, with respect to qualification for a survivor allowance, inability to engage in any substantial gainful occupation by reason of any physical or mental impairment which is determined on the basis of competent medical opinion secured by the board, to be of permanent or extended and uncertain duration.

You are permanently and totally disabled if you cannot engage in any substantial gainful activity because of your physical or mental condition. A physician must certify that the condition has lasted or can be expected to last continuously for 12 months or more, or that the condition can be expected to result in death. See Physician’s statement, later.  IRS  Publication 524

 If a full-time registered student withdraws from school on a medical leave of absence due to a health problem which prevents attendance at school, the insurer cannot deny dependents medical coverage for the health problem on grounds that the student is no longer a full-time student and is thus no longer insured. Custom Digest (217K2459)Prudential Ins. Co. of America, Inc. v. Superior Court, 119 Cal.Rptr.2d 823Cal.App.6.Dist.,2002

AB 910 2007 (pdf) Notification of loss of dependent status

Knox-Keene Health Care Service Plan Act of 1975 (DMHC Website)
Health & Safety Code 1340 et seq

Knox Keene Protections
Knox Keene

Insurance Company Policy Provisions

Unmarried disabled offspring over age 23, if incapable of self-support due to a continuous physical or mental disability that began before age 23. This child may remain an enrolled dependent unless the disability ends. To verify a disabled child’s status check out these forms:   Empire Blue Form

…• Dependent children under age 19 (or age 25 if they are full-time students).
• Dependent children of any age who are permanently disabled, and who were continuously enrolled in the District’s plans before age 19.
LAUSD _–   Eligible Dependents Include

Disabled child age 19 or older-You may be required by the plan administrator(s) to provide a copy of the guardianship papers indicating that the child is dependent upon you for support, and provide proof of the child’s disability. To be eligible for this coverage, the child must have been enrolled for coverage before age 19. Coverage may continue as long as you remain an eligible employee or retiree, and your disabled dependent meets the plan’s eligibility requirements.  (LAUSD Website)

Coverage for a disabled child may continue past age 18 if your health plan determines that your child became disabled before the limiting age (check with your health plan to determine the limiting age).  LA County Employees Page 4

Blue Shield CA Group – Page 9

Disabled over-age dependent children

If a disabled child who is covered under your Blue Shield plan reaches the maximum age limit specified in your Group Health Service Contract, Evidence of Coverage or Certificate of Insurance, coverage may continue if the child meets both of the following criteria. He or she is:

• Incapable of self-sustaining employment because of a mental or physical handicap, and

• Unmarried and dependent on the employee for economic support.

The child’s primary physician must submit to Blue Shield a written certification of the disability at all of the following times:

• Thirty-one days before the child reaches the maximum age limit, and

• Six months after the child’s coverage would have ended, and then annually thereafter.

In addition, the employee must submit a Declaration of Disability for Over-Age Dependent Children (see page A.5).

 

Thanks for the quick reply.

I actually just got a call from the Benefits Dept. Because I am under a large group HMO, they agreed that per Ca Insurance Code 10277, my daughter does qualify for coverage to be reassessed in one year.

Your website was the one that alerted me to this and I thank you so much for the part it played in helping me pursue this!

Best Regards,
Debbie

Dear steve,

New message from Debbie
Subject Over age 26 Dependent Disability on Large Group Plan
Message Hello,
I just have a question about this insurance code 10277. I have insurance thru a large group plan and my daughter was diagnosed before age 26 and meets the criteria for disabled dependent. They are denying her saying they are only under fed rules and that she needed to be ill before age 19.

***I would need to see the letter.employers.healthreformquotes.com

Under Health Care Reform, everything is guaranteed issue… Is it worth arguing about?  Just get a new quote.  quotit.net

Does the employer qualify as being out of state? employers.healthreformquotes.com

Does this sound correct to you? Thanks for any insight you can lend.

 

Support of Adult Child  3910

See Article on 50 year old attorney with depression

THE DUTY TO SUPPORT ADULT DISABLED CHILDREN
child support guidelines.com

Support of Grandchild ……   3930
Liability to Others Who Provide Support for Child   3950-3952
COURT-ORDERED CHILD SUPPORT
General Provisions 4000-4014
Statewide Uniform Guideline  4050-4076
Enforcement by District Attorney 4200-4205
Child Support Commissioners 4250-4253

Related Pages in Dependent Definition section

One comment on “Disabled Children – over 26

  1. 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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