How long can a disabled child stay on parents health insurance?
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
Child & Related Pages in Dependent Definition section
- Financial Support mandated of adult disabled child – SSI – SSDI
- Rules from Insurance Companies on coverage for disabled children
- Text of Law – Mandating coverage for disabled children §10277
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
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.
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.
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!
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Most of what the video says is RIGHT, not grandfathering though. Let me know if you find a video more on point
Links & Resources
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