518 Insurance Coverage for Dependent Children

 

Policy

 

This policy only applies to the Adult group.  When a parent or other relative is living with a child and is the child’s main caretaker, the child must have minimum essential coverage for the person to qualify for the Adult group.

Parents are always considered the main caretaker when living with the child, even if another relative is also in the home. 

 

 

Definitions

 

Term

Definition

Child

·         A person under the age of 18, or

·         An 18-year old who is a full-time student in high school or a trade school and expected to graduate before turning 19.

Minimum Essential Coverage

Means any of the following kinds of health insurance coverage:

·         Full AHCCCS Medical Assistance benefits;

·         Medicare Part A;

·         TriCare for Life;

·         Veterans health program;

·         Government health plan for Peace Corps volunteers;

·         Group and Individual health plans, including Qualified Health Plans purchased on the Federally Facilitated marketplace;

·         Employer-sponsored coverage; or

·         Other health benefits coverage, such as a State health benefits risk pool.

Minimum Essential Coverage does NOT include:

·         Coverage only for accident, or disability income insurance;

·         Liability insurance, including general liability insurance and automobile liability insurance;

·         Workers’ compensation or similar insurance;

·         Automobile medical payment insurance;

·         Coverage for on-site medical clinics;

·         Dental- or vision-only benefits;

·         Coverage only for long-term care services;

·         Coverage only for a specified disease or illness; or

·         Hospital indemnity or other fixed indemnity insurance.

Parent

Means a natural, adoptive or step-parent.

Relative

Means any of the following:

·         Grandparent (including great-grandparent)

·         Brother or sister (including stepbrother or stepsister)

·         Uncle or aunt (including great-aunt or great-uncle)

·         Cousin (includes 1st and 2nd cousins)

·         Nephew or niece

·         The spouse of any of the relatives listed above, even after the marriage is ended by death or divorce.

 

Proof

 

Proof that a child has minimum essential coverage includes any of the following:

·         Health-e-Arizona plus system or records showing the child has full MA coverage;

·         Current documents showing the child is enrolled in a group or individual health plan; or

·         Telephone call to the insurer confirming the child has minimum essential coverage.

 

Legal Authorities

 

Program

Legal Authorities

Adult

42 USC 1396a(a)(10)(A)(i)(XIII)

42 CFR 435.119