elaws - Health Benefits Advisor
elaws - employment laws assistance for workers and small businesses - Health Benefits Advisor

Not Covered Under Parent’s Group Health Plan on Last Day

If you were not covered by either parent's group health plan on the day before you became ineligible to be considered a dependent child under the plan terms, you do not have a right to COBRA continuation coverage.

However, there may be other options available that may assist you. You may be eligible for Medicaid, Medicare, SCHIP (State Children's Health Insurance Program) or other health coverage.

In choosing among the options available to you, you should review the SPD (summary plan description) for each available group health plan to determine which plan best meets your needs. You should also review and compare the information on the other coverages for which you are eligible. In making your decision, you may want to consider such things as:

  1. Any waiting period (or affiliation period) imposed under the plans;
  2. Types of benefits offered (Is dependent coverage available? Do the benefits cover your family's medical needs?);
  3. Cost of coverage (premiums, co-payment and deductibles for prescription drugs and doctor visits);
  4. Limitations on coverage (annual or lifetime dollar limit, visit limits, pre-existing condition exclusion periods, prescription drug coverage limits or limits on the availability of doctors and hospitals); and
  5. Any exclusions from coverage (treatments, procedures, conditions or prescription drugs).

Whatever coverage you choose, you should try to avoid incurring a significant break in health coverage, especially if you or a family member has a medical condition that requires regular medical attention. A significant break in coverage is a period of 63 consecutive days (longer in some states) during which you have no health coverage. Depending on the circumstances, avoiding a significant break in coverage may help you and your family shorten or eliminate any pre-existing condition exclusion period or to qualify for certain coverage with special protections described under other health coverage.