Health Ins/Dependents @ 19 years

[Khuffstutter]

What is the name of your state? Louisiana

My son was involved in a motorcycle accident 10/16/03 and was hospitalized for 2 weeks. He was 18 at the time, and covered by his father's EPO policy. On November 13, 2003, he turned 19 and is not a full time student. Consequently the insurance company is saying their legal responsibility for his claims ended November 13, 2003 and they will not pay any bills incurred by him from that date forward regarding the October accident. His injuries were extensive and the doctors are saying 8-10 months of future rehabilitation and no work. Can the company just drop coverage on him on his 19th birthday and have no responsibility for on-going charges related to a covered accident??

There was no medical coverage under the motorcycle policy to cover any expenses, so the charges are being filed on the health policy only.

 

[cbg]

Yes, they can do this. They have no obligation to cover him once he is no longer an eligible dependent. The fact that he is in the middle of treatment does not change his eligibility status.

 

[lkc15507]

Khuffstutter:

I think your son should be offered continuation of coverage under federal COBRA law. As CBG says, the plan has no obligation to provide coverage based on ongoing treatment, but by paying the premium, he should be eligible for coverage for at least 18 months. In the meantime, look to see what the summary plan description of your plan states regarding eligibility of a disabled dependent. Also, oftentimes a state Medicaid program will pay a COBRA premium for an individual if he / she qualifies.

Best to you,

lkc15507

 

[cbg]

Good point, lkc, thanks for picking up on that. I should have mentioned COBRA.

 

[lkc15507]

LOL cbg! If I only had a dime for each time your expert advice pointed the right direction in the first place! Answers would be much harder! Health insurance is a complicated subject and hopefully all minds combined can eventually arrive at the right answers.

Take care,
lkc15507