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Steve Shorr Insurance
Health Insurance Law 

Dependent Definitions

Video - Introduction

Steve Shorr, President,
CPCU, REBC, RHU

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Established   1981


Health Reform
Medical Loss Ratio
Exchanges
Constitutionality
Grandfathering
Pre-Existing FAQ's
Mental Health Parity
Misstatements
Worker's Comp.
Dictionary
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Dependent Definitions
Miscellaneous
FAQ's
Resources
Site Map
Steve Shorr.com

Tell me more about the new definition of dependent children to age 26?

...Group or individual health insurance coverage that provides dependent coverage of children shall continue to make such coverage available for an adult child (who is not married) until the child turns 26 years of age.
(
(Obama's Plan SEC. §2714(a). EXTENSION OF DEPENDENT COVERAGE.,

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

At age 27 check out:

COBRA
Cal COBRA
Individual & Family Plans - just getting a new policy or requesting a change to their own policy.
Get a FREE California Quote
Quotes outside of CA
Disabled?

Cal COBRA

Children < 19  Disabled?  Grandfathering

FAQ's

HHS.Gov
HHS.Gov FAQ's dependents under age 26

Consumer Links

Medical Insurance Forms & Applications
CA Forms & Applications

Individual Companies Procedures and Interpretations Microsoft Word
Individual Insurance Interpretations and Procedures

Anthem Blue Cross 9/1/2010 Bulletin

Blue Shield Info

Technical Links

Regulations
Federal Register Dependent Children Requlations under age 26
Our Marked Up Copy

HHS Fact Sheet

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

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

Blue Cross Small Group Administrative Manual

Definition of Dependent Internal Revenue Code  IRC §152
a)  ''dependent'' means any of the following individuals 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

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.
Staying on Health Plan if Disabled
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)

Historical Links

Blue Shield will cover up to age 26 as of 4/21/2010
5/13/2010 update

Blue Cross FAQ's 4/30/2010

LA Times 4/4/2010 Article

Click to Enlarge
Open Enrollment
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. (kp.org/HR2851) (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)

Over Age Dependent Form - Health Net

Blue Shield Individual
Page 7 pdf.blueshieldca.com/
Page 43 id

  • Medical Loss Ratio Exchanges Constitutionality Grandfathering Pre-Existing FAQ's Mental Health Parity Misstatements Worker's Comp. Dictionary Grievance Dependent Definitions Miscellaneous FAQ's Resources Site Map
    Health Insurance Order
    "Working Spouse Rule"

 
 

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