All of your child's life, you've had the reassurance of knowing he's covered under your family health insurance plan. What happens once your child approaches adulthood? Can he continue under your coverage?

With more than 40 million people lacking health insurance in this country, can you make sure your child won't become one of them?

Generally, a child will cease to be covered under a parent's medical insurance plan around the age of 19, but there are several factors that can alter this situation.

One is college. If the young person becomes a full-time student, coverage on the parent's plan may be extended to age 22 or even later, depending on the policy.

The other factor is disability. Having a form of muscular dystrophy, spinal muscular atrophy or other progressive neuromuscular disorder should qualify your child to continue being covered on most plans, perhaps indefinitely, as long as he's actually living at home, is unmarried and is unable to support himself due to his disability.

Taking the Initiative

It'll be up to you to contact your insurance provider and request that your child be maintained on your policy indefinitely as a dependent because of the disability. Don't expect the provider to notify you. You'll need to take this step prior to the time your child would normally be taken off the policy due to age. You'll need medical substantiation of your child's disability in the form of a letter from the child's doctor.

At the same juncture, when your child would normally be dropped from your policy due to age, you may opt for a conversion contract, which will convert your child's coverage under the family policy to his own individual coverage. Again, it's your responsibility to contact the insurance provider about exercising this option.

Coverage under the conversion policy may be less comprehensive, while costing more, and this option may be a viable one only if you expect that your child will eventually be able to support himself. Otherwise, having the child continue as a dependent on your family policy may be preferable.Lisa Jolles, an independent insurance agent in Woodstock, Md., recommends that parents become familiar with the details of their contract before the stage at which decisions need to be made. She says it's hard to generalize about coverage because each individual contract is different.

"People need to find a contact at the insurance company, usually a case manager," Jolles says. "That person can really be your ally, someone who can answer questions and who 'sees' you on a personal level."

Dealing With Bureaucracy

Even when a child has a severely progressive disorder such as Duchenne muscular dystrophy, you may have to "recertify" him on a yearly basis to maintain his coverage under your policy, which means resubmitting information from the child's doctor each year.

You might reasonably expect that having once established the presence of a disease like Duchenne, you wouldn't be required to restate the child's status as a dependent each year. Unfortunately, the bureaucratic nature of the insurance process will invariably require that the forms be filled out anew each year, just as each year a child's full-time college status would also have to be recertified.

Helpful Legislation

COBRA (Consolidated Omnibus Budget Reconciliation Act) refers to a federal law enacted in 1986 and amended several times since that helps people remain on health coverage provided through a job, when coverage might otherwise be discontinued due to such factors as job termination or death of an employed spouse.

Dependent children can benefit under this law. The dependent child of an employee has the right to continue health care coverage under certain circumstances, such as the death of a parent or termination of a parent's employment.

However, having the right to continue coverage doesn't mean that the coverage is free. Premiums once paid for by payroll deductions taken from the employee's paycheck will have to be paid on time by the dependent to keep the coverage active.

What's more, this continued COBRA coverage is only available for a certain period. It should be available for three years, unless group health insurance was lost due to termination of employment or reduction in hours, in which case the period is 18 months.

However, under provisions of the Health Insurance Portability and Accountability Act (HIPAA) of 1996, also known as the Kennedy/Kassebaum law, that 18-month period can be extended to 29 months, if the individual entitled to continued coverage is determined by the Social Security Administration to have become disabled during the first 60 days of COBRA continuation coverage. The HIPAA law has other implications for individuals with disabilities. Normally, the presence of a neuromuscular disorder or other serious health condition is labeled a "pre-existing condition" and can be an obstacle to obtaining coverage. HIPAA limits the circumstances in which insurance plans can exclude someone from coverage based on a pre-existing condition.

This could be useful if a family had to switch to a new provider because of a job change or because coverage provided under COBRA had run out.

For more information on COBRA and HIPAA laws, you can visit the U.S. Department of Labor's Pension and Welfare Benefits Administration Web page at http://www.dol.gov/dol/pwba or ask for a brochure by calling (800) 998-7542.

Other Options

One way to obtain coverage despite a pre-existing condition is the conversion contract option, mentioned earlier. Another way is through "open enrollment" coverage, which is periodically offered by some insurance providers. This is a sort of "blind" policy in which providers open the door to everyone, regardless of pre-existing conditions.

However, for conversion and open-enrollment contracts, providers tend to protect themselves by raising the premiums and by limiting the kind of coverage. Such policies should be carefully examined to see if they'll really cover costs, such as medication, that are often an important part of living with a disabling condition.

Jolles says bargains can be found, so it's worth hunting around.

Government Programs

The Social Security Administration offers two kinds of benefits for people it determines to be unable to work due to a disability. Social Security Disability Insurance is for those who've worked a number of years, while Supplementary Security Income is for those without a qualifying work record who have low income and minimal assets.

Each program has a government-administered health insurance program associated with it, Medicare and Medicaid respectively. In the case of Medicare, a two-year waiting period usually follows a positive disability determination before benefits begin.

It's possible for a child with a disability to qualify for Medicare benefits under his parents' work record. Call your local Social Security office or (800) 772-1213 for more information.