Blue Cross - Specimen Definition
Blue Cross – Specimen Definition

Dependent children can stay on their parents policy to a new maximum age of 26

…Group or individual health insurance coverage that provides dependent coverage of children shall continue to make such coverage available for an adult child  until the child turns 26 years of age.   College attendance or student status is no longer an issue! ((Obama’s Plan SEC. §2714(a). EXTENSION OF DEPENDENT COVERAGE. FACt Sheet  ,  Blue Cross Specimen Individual Policy       Regulations & Guidance   

Insurer’s must notify you, when you lose  dependent status  (AB 910 2007)

At age 26 check out:

Get FREE CA Quotes under Health Care Reform

Outside of CA


Lifetime Coverage for disabled child over 26

Overage Dependents Notice


Covered California –  In most cases, dependents who reach 26 years of age are not qualified to remain on their current family plan. consumer notice   *   Overage Dependent Quick Guide 




Do Insurance Companies ever audit – check if dependents are really eligible?

Cal Pers drops 18k from Insurance Rolls  CA Health Line 10.21.2015

Consumer Links

Specimen Health Reform Individual Platinum Policy – Eligible Dependents Page 25


Regulations & Guidance

CA Forms & Applications

Anthem Blue Cross 9/1/2010 Bulletin

UHC Group Policy Extract

HealthCare.Gov     White House.Gov   Affordable Health Care Act   YouTube Channel

Technical Links

Our Marked Up Copy of Federal Register

CA enacted SB 1088 2010 Price Insurance Code 10277 to require Insurers to conform with PPACA (Obama’s Plan)

Federal RegulationsStudent Health Plans

Blue Cross Small Group Administrative Manual

Loss Ratio is higher for kids on parent’s plan vs those who have their own coverage Washington Post

Staying on Health Plan if Disabled

Blue Cross
Employer enforcement of exclusion for dependents who are eligible for their own employer-sponsored coverage

The health care reform law allows grandfathered group health plans to exclude coverage for young adult dependents who are eligible for their own employer-sponsored coverage. While we aren’t making this exclusion standard, 100+ grandfathered groups can choose to have the exclusion.

If a group chooses to exclude coverage for dependents who are eligible for their own employer-sponsored coverage, we will add the exclusion to the group’s certificate language. However, we will not enforce the exclusion on behalf of the group. The employer will need to develop a method that suits its particular needs, as well as materials that support the enforcement method (such as an affidavit for employees to verify that their covered dependents are not eligible for their own coverage).  (Blue Cross 12/3/2010 Bulletin)

Definition of Dependent Internal Revenue Code  IRC §152  a)”dependent” means any of the following individuals (click here for list)  over half of whose support, for the calendar year in which the taxable year of the taxpayer begins, was received from the taxpayer (or is treated under subsection (c) or (e) as received from the taxpayer): IRS Publication 501   Our Site on 1040 including instructions  

Historical Links

Covered CA problems with implementing the law.

5/13/2010 update

Blue Cross FAQ’s 4/30/2010

LA Times 4/4/2010 Article

Open Enrollment
Open Enrollment 2010

Click to Enlarge

Blue Cross Anthem Open Enrollment
November for January 1 Effective Date
Application – Change Form

  • Commercial health plans and insurers are prohibited from terminating coverage for full-time dependent students over 18 during a break in the school calendar or a medically necessary academic leave of absence.
  • Coverage continues for up to one year or until coverage is scheduled to terminate under the plan’s terms and conditions, whichever comes first.
  • Documentation of the medical necessity must be submitted to the Insurance Company  if the health plan certifies the students for coverage. ( (SB 1168)

Eligible Dependents
Policy Definitions

The following persons, if not otherwise covered as subscribers in your Blue Cross plan or in military service, are considered eligible dependents:

The lawful spouse of the opposite sex –

  • so, if you’re getting divorced you can stay on,  till the divorce is final.  You’re spouse cannot take you off the coverage out of spite – Standard Family Law Restraining Orders FL 110

• A certified domestic partner
See article on State Bar Web site

• Any unmarried, biological or legally adopted child (see “Children” subsection for age requirements)

• A stepchild of the subscriber or enrolled spouse

• A child (ward) of a subscriber or the subscriber’s enrolled spouse who is named the permanent legal guardian

• A dependent child of a domestic partner, only if he/she is the employee’s biological or adopted child and only if domestic partner eligibility has been elected by the employer Source Page 15 Blue Cross Administrators Guide AB 1672 Definition of  Dependent Health Net – Page 18 Employer Manual  Blue Cross Individual Dental Definition – Page 11 of their brochure

Dependents (age 19 through 23) attending school full-time, include name of dependent, name/address of school, and number of credits PacifiCare Individual Definition

Right of Non Custodial Parent to Obtain Medical Information  (Family Law Code 3751.5)

Blue Shield Individual
Page 7 pdf. blue shield
Page 43 id

Health Insurance Order
“Working Spouse Rule”

Learn more about the Self Employed Deduction to Age 27
Obama’s Plan

Dependent Children can now be covered to Age 26 detailed information on

Family – Income Tax MAGI

Cal Pers drops 9k dependents as they don’t meet the definition

Health Care Reform….  Excerpt from Wikipedia
Due to the new regulations of guaranteed issue, and allowing children to be included on their parents’ plans until age 26, several insurance companies announced that they would stop issuing new child-only policies.[131][132][133] However, because children would now be covered by their parents’ plans, the Census Bureau found that the number of uninsured 19- to 25-year-olds had declined by 1.6% or 393,000 people by 2011.[134] Starting January 1, 2014, state health insurance exchanges will be required to offer a child-only coverage option, and Medicaid eligibility will be made available to 16 million individuals with incomes below 133% of the federal poverty level.[135]

When your child/stepchild gets married or turns 23 (whichever comes first), the child is no longer considered your dependent.

There is one exception: when your child turns 23 but is incapable of self-support because of a physical or mental disability that has existed from before the age of 23. In this case, the child may remain a dependent until the incapacity ends.

Other pages in EmployER Definition – Health Care Reform » EmployEE Definition  Section


children definition age
disabled dependent over age 26



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