Tom Schrette and Alan Cash

Tom Schrette and Alan Cash

Dear Tom and Alan:My daughter is about to turn 26. Our insurance company sent a letter saying she will no longer be on our family plan.

Will the company offer her or transition her to a new plan automatically?

Or, is this something we have to work on?


Tom: We call that the “aging out” letter.

It would make great sense for the insurance company to just roll her out of your plan and on to a new plan like she has now, but, NO, she will have to apply for a new plan.

We are currently outside the open enrollment period that runs from Nov. 1 to whenever the government decides to end it. This year, it ended Jan. 31 in California.

Since we are outside the open enrollment period, a “qualifying event” is required in order to sign up for any plan.

Turning 26 and leaving your parents’ plan is one of many qualifying events.

One would think that her date of birth stated on a new application would be sufficient for an insurance company to trigger the new benefits and offer her a plan due to her qualifying event, but, NO again.

She will need the letter YOU received stating her name, the date the coverage ends, and her policy number…all on the letterhead of the insurance company.

This letter is called the Special Enrollment Period (SEP) eligibility document. She has 60 days to enroll in the new plan.

Beyond 60 days from her end date makes her ineligible until the next open enrollment period.

Al: I’m seeing a slightly different scenario.

My grandson is soon going to be 26 and will have to come off his father’s plan through work.

In this case, the SEP eligibility document has to come on the employer’s letterhead.

The quirky part of all of this is that on most letters, whether from employers or insurance companies, the only name mentioned is the primary subscriber — never a dependent!

Anyway, it’s still a qualifying event, so as long as the new application goes in before the 60-day drop-dead date, all is well.

Now, since my grandson lives in Los Angeles, he has about twice as many choices as someone in Napa.

To get an accurate quote for a new enrollee, I go to CoveredCa.com. Putting in the ZIP code, age, and income brings up a number of choices from bronze to platinum.

In the case of my grandson, 42 different choices came up, including several “catastrophic” plans that are only available to those under age 30.

In addition to Blue Shield, Kaiser, and Healthnet, Southern California also has OSCAR, Molina and L.A. Care.

The least expensive was OSCAR minimum coverage EPO at $168.84; the most expensive was a platinum Blue Shield PPO at $618.74.

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Submit questions to schrette@gmail.com or alancash@gmail.com.