A group health insurance policy that provides coverage of a dependent child of an employee or other member of the covered group will not terminate upon attainment of the limiting age for dependent children if the child is (1) incapable of self-sustaining employment by reason of a physical or mental injury, illness, or condition; and (2) chiefly dependent upon the employee or member for support and maintenance. The employee or member must submit proof of the physical or mental condition before the child attains the limiting age.
With respect to a group health insurance policy that provides coverage for a dependent child over 18 years of age and enrolled as a full-time student at a secondary or postsecondary educational institution, if the dependent child takes a medical leave of absence from school but the nature of the dependent child's injury, illness, or condition would render the dependent child incapable of self-sustaining employment, then the child still qualifies for coverage if he/she is chiefly dependent on the policyholder for support and maintenance.
With respect to an individual health insurance policy that provides coverage for a dependent child over 18 years of age and enrolled as a full-time student at a secondary or postsecondary educational institution, if the dependent child takes a medical leave of absence from school but the nature of the dependent child's injury, illness, or condition would render the dependent child incapable of self-sustaining employment, then the child still qualifies for coverage if he/she is chiefly dependent on the policyholder for support and maintenance.
