Blue Shield Dependent Definition - Disabled
Blue Shield Dependent Definition – Disabled

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.

Our Blue Shield of CA medical EOC says:

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.

***Please when stating facts, provide a screen shot, URL – Internet Address or something.   Here’s an actual EOC – Evidence of Coverage from Blue Shield for the PPO Platinum Plan.   We don’t like hearsay  (Federal Rules of Evidence)

Here is what we show:

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. CA Insurance Code 10277 (d)

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.  Page 60 of the EOC
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Page 15 of the Group Administration Guide says virtually the same thing.
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Our wholesalers – General Agent’s website says:
Yes, pending approval from Patient Management Group Department at Blue Shield of California.
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Health Care Reform, AB 1083 and prior AB 1672 makes Employer Group Coverage GUARANTEED issue, no Pre-Existing Condition Clause, NO Medical Questions!
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On the Federal Level in 1996 HIPAA was passed to include portability for an employee to be able to go from one employer’s health plan to another…  no job lock.
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This caused us to lose at least one new hire, because she decided to stay on her current medical plan (with her current employer) that provides coverage for her disabled adult child.

***I suggest you appoint us as your agent and we will fill out the disabled child form, along with the employee application and get a WRITTEN answer, not a “bozo” oral – hearsay  (Federal Rules of Evidence) answer.

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