Considering that everything is guaranteed issue, with no Pre X starting
1.1.2014, I don't think this page will be relvant anymore. In addition,
Mental Health Benefits are an
essential benefit under Health Care Reform.
Rules Regulations were JUST issued... Click here for
Quotes in CA.
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.
Medicare Advantage Plans
599.500 CCR Cal Pers
New York NYSHIP
findlaw.com/ny code 4305
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
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
Handicapped Child Continuation of Medical Coverage
Handicapped Child Attending Physical Statement
drug abuse mental health and better health
Diabetes.org discusses medical problems, but not being disabled, many of the options though are the same for both problems