[Section 4089d effective until January 1, 2020; see also section 4089d effective January 1, 2020 .]

§ 4089d. Coverage; dependent children

(a) As used in this section, "health insurance plan" shall mean any group or individual policy, nonprofit hospital or medical service corporation subscriber contract, health maintenance organization contract, self-insured group plan, and prepaid health insurance plans delivered, issued for delivery, renewed, replaced, or assumed by another insurer, or in any other way continued in force in this State.

(b) A health insurance plan that provides for terminating the coverage of a dependent child upon attainment of the limiting age for dependent children specified in the policy shall not limit or restrict coverage with respect to an unmarried child who:

(1) is incapable of self-sustaining employment by reason of a mental or physical disability that has been found to be a disability that qualifies or would qualify the child for benefits using the definitions, standards, and methodology in 20 C.F.R. Part 404, Subpart P;

(2) became so incapable prior to attainment of the limiting age; and

(3) is chiefly dependent upon the employee, member, subscriber, or policyholder for support and maintenance.

(c) Coverage under subsection (b) of this section shall not be denied any person based upon the existence of such a condition; however a health insurance plan may require reasonable periodic proof of a continuing condition no more frequently than once every year.

(d) A health insurance plan that covers dependent children who are full-time college students beyond the age of 18 shall include coverage for a dependent's medically necessary leave of absence from school for a period not to exceed 24 months or the date on which coverage would otherwise end pursuant to the terms and conditions of the policy or coverage, whichever comes first, except that coverage may continue under subsection (b) of this section as appropriate. To establish entitlement to coverage under this subsection, documentation and certification by the student's treating physician of the medical necessity of a leave of absence shall be submitted to the insurer or, for self-insured plans, the health plan administrator. The health insurance plan may require reasonable periodic proof from the student's treating physician that the leave of absence continues to be medically necessary. (Added 1975, No. 237 (Adj. Sess.), § 1, eff. April 7, 1976; amended 1983, No. 165 (Adj. Sess.), § 2; 2005, No. 199 (Adj. Sess.), § 1.)

[Section 4089d effective January 1, 2020; see also section 4089d effective until January 1, 2020 .]

§ 4089d. Coverage; dependent children

(a) As used in this section, "health insurance plan" means any group or individual policy; nonprofit hospital or medical service corporation subscriber contract; health maintenance organization contract; self-insured group plan, to the extent permitted under federal law; and prepaid health insurance plans delivered, issued for delivery, renewed, replaced, or assumed by another insurer, or in any other way continued in force in this State.

(b) A health insurance plan that provides dependent coverage of children shall continue to make that coverage available for an adult child until the child attains 26 years of age, provided that this subsection shall not apply to a plan providing coverage for a specified disease or other limited benefit coverage, and further provided that nothing in this subsection shall require a plan to make coverage available for the child of a child receiving dependent coverage.

(c)(1) A health insurance plan that provides for terminating the coverage of a dependent child upon attainment of the limiting age for dependent children specified in the policy shall not limit or restrict coverage with respect to an unmarried child who:

(A) is incapable of self-sustaining employment by reason of a mental or physical disability that has been found to be a disability that qualifies or would qualify the child for benefits using the definitions, standards, and methodology in 20 C.F.R. Part 404, Subpart P;

(B) became so incapable prior to attainment of the limiting age; and

(C) is chiefly dependent upon the employee, member, subscriber, or policyholder for support and maintenance.

(2) Coverage under subdivision (1) of this subsection shall not be denied any person based upon the existence of such a condition; however a health insurance plan may require reasonable periodic proof of a continuing condition no more frequently than once every year.

(d) A health insurance plan that covers dependent children who are full-time college students beyond 18 years of age shall include coverage for a dependent's medically necessary leave of absence from school for a period not to exceed 24 months or the date on which coverage would otherwise end pursuant to the terms and conditions of the policy or coverage, whichever comes first, except that coverage may continue under subsection (b) of this section as appropriate. To establish entitlement to coverage under this subsection, documentation and certification by the student's treating physician of the medical necessity of a leave of absence shall be submitted to the insurer or, for self-insured plans, the health plan administrator. The health insurance plan may require reasonable periodic proof from the student's treating physician that the leave of absence continues to be medically necessary. (Added 1975, No. 237 (Adj. Sess.), § 1, eff. April 7, 1976; amended 1983, No. 165 (Adj. Sess.), § 2; 2005, No. 199 (Adj. Sess.), § 1; 2019, No. 63, § 5, eff. Jan. 1, 2020.)