Who is Eligible and How to Enroll for Coverage
To enroll in and receive coverage under IEHP Covered, the subscriber and each family member that apply for enrollment must:
- Live in the IEHP Service Area (San Bernardino or Riverside County) throughout the eligibility period.
- Be a citizen or national of the United States or an alien lawfully present in the United States.
- Not be incarcerated.
- And must apply during an open enrollment period or during a special enrollment period.
The following individuals and lawful spouses are not eligible for coverage under IEHP’s Covered plans:
- Individuals eligible for a group plan with minimum essential coverage.
- Individuals aged 65 and older and eligible for Medicare benefits, except for dependent parents or stepparent.
- Individuals who are incarcerated.
- Individuals eligible for Medi-Cal or other state or federal programs.
If you have end-stage renal disease (“ESRD”) and are eligible for Medicare, you remain eligible for enrollment until you are enrolled in Medicare. The plan will work with you to obtain Medicare coverage if you qualify.
Subscribers may apply to enroll family members who satisfy the eligibility requirements for dependents:
- Spouse: The subscriber’s lawful spouse, as defined by California law. (The term “spouse” also includes the subscriber’s domestic partner when the domestic partnership meets all requirements under California law.)
- Children: The children of the subscriber or his or her spouse (including legally adopted children, stepchildren, and children for whom the subscriber is a court-appointed guardian).
- A parent or stepparent who meets the definition of a qualifying relative under Section 152(d) of Title 26 of the United States Code and who lives or resides within the IEHP service area.
Dependent Children
Each child is eligible for enrollment as a covered dependent until the age of 26. An enrolled dependent child who reaches age 26 may remain enrolled as a dependent until the end of that calendar year. The dependent coverage shall end on the last day of the calendar year during which the dependent child becomes ineligible.
Covered dependents who reach age 26 are eligible for continued benefit coverage under the parent/guardian’s plan if both of these conditions apply:
- The child is incapable of self-sustaining employment by reason of a physically or mentally disabling injury, illness, or condition; and
- The child is chiefly dependent upon the Subscriber for support and maintenance.
IEHP will provide You notice at least 90 days prior to the date at which the dependent child’s coverage will terminate. You must provide IEHP with proof of your child’s incapacity and dependency within 60 days of the date you get this notice from IEHP to continue coverage for a disabled child past the age limit. You must provide the proof of incapacity and dependency at no cost to IEHP. A disabled child may remain covered by IEHP Covered as a dependent for as long as he or she remains incapacitated and keeps meeting the eligibility standards described above.
Refer to the “Eligibility, Enrollment, and Termination” section of the EOC for more information regarding eligibility, Open Enrollment, and Special Enrollment Periods.