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Disabled Dependent's


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Considering that everything is guaranteed issue, with no Pre X starting 1.1.2014, I don't think this page will be relevant anymore.  In addition, Mental Health Benefits are an essential benefit under Health Care Reform.  New Final Rules Regulations were JUST issued...  Click here for Guaranteed Issue - No Medical Questions asked Quotes in CA or Nation Wide.  If in CA email us your questions.

What if my disabled child is over 26?

An individual or group health insurance 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

"Health Insurance" ... shall mean a  policy that provides coverage for hospital, medical, or surgical benefits.§106

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.

Consumer Resources

Guaranteed Coverage for Children < 19

Buy Disability Insurance   Health Care Reform to Age 26 

Child Support for Adult?

Text of Law

Dual Coverage

Medicare Eligible

Medicare Advantage Plans

Medi Gap

599.500 CCR  Cal Pers

tacanow.org

New York NYSHIP
findlaw.com/ny code 4305

 

Legal Codes

 

Government Code § 9373"Disability," "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.

Permanent and total disability.    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).

Proof of Disability Forms

 Federal Government - Disabled Dependent Form

Langford University

Aetna Forms

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

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    drug abuse  mental health and better health
    Health Care Reform to Age 26
    Guaranteed Coverage for Children < 19

    Buy Disability Insurance

    Diabetes.org discusses medical problems, but not being disabled, many of the options though are the same for both problems

     

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