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Questions Regarding Children's Maryland Health Insurance Coverage

Frequently Asked Questions

More Coverage Issues

How Long May I Keep My Child On My Health Plan?

On January 1, 2008, Maryland law changed to allow a dependent child to remain on a parent's health insurance policy up to the age of 25 under certain circumstances.

Please remember this law only applies to fully insured health plans issued in the State of Maryland to individuals or employers with 51 or more employees. Your employer may elect to provide more beneficial coverage for dependents. Check with your employer or health plan to verify your coverage for dependents. The law does not apply to individuals whose health coverage is provided through: (1) federal plans or programs (Federal Employee Benefit Plan, Medicare, Medicaid); (2) self-funded groups or union plans; (3) group or individual coverage issued and delivered outside the state; or (4) a small employer (an employer with at least two but no more than 50 employees). Your employer or insurer can tell you if the new law applies to your coverage.

If your child is a full time student, unmarried and is a "qualifying child" as defined by the Internal Revenue Service (IRS), then your child may remain on a parent's policy until the end of the year in which your child reaches age 23. While the IRS criteria may change, as of September 2008, a qualifying child is one who:

does not provide over one-half of his or her own support; and
meets the following residency test:
- the child lives with you for more than one-half of the year; or
- meets the following alternative residence test:
  - the child receives over half of the child's support during the calendar year from the child's parents;
  - the child is in the custody of one or both parents for more than half of the year; and
  - the child's parents:
    - are divorced or legally separated under a decree of divorce or separation order signed by a judge;
    - are living separately under a written separation agreement; or
    - live apart at all times for the last six months of the calendar year.

If your child is not a full-time student but is a "qualifying relative" as defined by the Internal Revenue Service, the child may stay on a parent's policy until he or she reaches age 25. For your child to be a qualifying relative, you must supply over half of the child's support and the child must not be a qualifying child of any person, including you.

Be sure to check with your tax adviser or the IRS to be sure your child meets the definition of a qualifying child or qualifying relative.

Also, if your child is permanently and totally disabled and is incapable of self support due to mental or physical incapacity, your child may remain covered under a parent's policy. For additional information about coverage options for a disabled child, please contact your insurer or employer.

Once your child is no longer eligible for coverage under a parent's policy, the child does have other options. He or she may qualify for COBRA coverage. Not all group policies have COBRA provisions. Check with your insurer or employer to see if COBRA coverage is an option for your child. Be sure you understand the requirements for obtaining COBRA coverage, the cost and the covered benefits.

Your child may purchase coverage directly through an insurer in the non-group market. There are many insurers that offer coverage in the individual market and some have policies specifically designed to meet the needs of younger adults. In Maryland, these policies are subject to medical underwriting. When your child applies for individual coverage, he or she will be asked to fill out a health risk assessment form.

If an insurer refuses to issue a policy because your child has a particular health condition and your child is not eligible for COBRA coverage, your child may qualify for coverage through the Maryland Health Insurance Plan (MHIP). Contact MHIP at 888-444-9016 to determine if this option is available.

If your child is covered under your HMO or PPO plan but is a student and does not live in the service area, you should ask your carrier how and where the child can seek services. For example, a student insured through an HMO may be outside the HMO service area of physicians and hospitals while away at school. If this occurs, the student likely will have coverage for emergency care, but may have to travel to a physician and hospital within the HMO service area for other care. Similarly, a health plan may pay benefits at out-ofnetwork levels for students who are outside a PPO network. Check your plan provisions or speak with your health plan to know the level of benefits provided when a student is at a school outside the service area.

Be sure the college student has a copy of the relevant insurance cards and knows how to obtain any required approvals before seeking treatment.

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