The Affordable Care Act requires plans and issuers that offer coverage to children on their parents’ plan, to make the coverage available

until the adult child reaches the age of 26, even if the young adult no longer lives with his or her parents, is not a dependent on a parent’s

tax return, or is no longer a student. The Departments of HHS, Labor, and Treasury have issued draft regulations implementing the new

requirement.

Questions and answers:

Does this provision impact current plans or just new plans? Does dependent requirement apply to all markets?

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For plan years starting six months after enactment (i.e., Sept. 23, 2010), all plans providing dependent coverage are required to make that coverage available to adult children — both married and unmarried — up to age 26. The administration has provided the following answers to consumer questions on its website, : "Six months from now [September 23, 2010], insurers will be required to permit children to stay on family policies until age 26. This applies to all plans in the individual market, new employer plans, and existing employer plans, unless your adult child has an offer of coverage through his or her employer (this last exception applies to grandfathered plans only until 2014). This requirement will take effect the next time your plan comes up for renewal. Adult children who are on their parents’ plan now but who lose that coverage when they graduate from college will have the option of rejoining their parents’ policy in the new plan year beginning six months from now. Those whose parents who work at self-insured companies will also be eligible if they do not have an offer of employer sponsored insurance."

Does dependent mandate apply to married children?

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Both married and unmarried dependents qualify for this dependent coverage. Coverage of the dependent’s spouse or children is not required.

Does it apply to grandfathered plans?

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This provision applies to both new and grandfathered plans. However, for plan years before January 1, 2014, grandfathered health plans may exclude an adult child if the adult child is eligible to enroll in an employer-sponsored health plan other than a group health plan of a parent. Beginning in 2014, grandfathered plans must comply with the requirement and children up to age 26 can stay on their parents’ employer plan even if they have an offer of coverage through their employer.

Do employers have to offer dependent coverage?

No, not if they do not already do so.

When will dependents who were previously disenrolled from coverage or who would meet the new provision of the federal law be allowed to enroll for coverage?

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For plan renewals beginning on or after Sept. 23, 2010 (or 01/01/2011 for individual policy renewals), dependents who meet the new dependent coverage requirements will be permitted to enroll in coverage under a parent’s plan per federal legislation. The enrollment period will align with the open enrollment period for their plan renewal.

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This enrollment opportunity must be provided not later than the first day of the first plan year beginning on or after Sept. 23, 2010 and must continue for at least 30 days.

Exactly when does coverage cease for dependents?

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The termination rules follow either the Aetna default (at the end of the month during which the dependent turns 26) any applicable state mandates (Florida, for example, mandates coverage dependent termination at the end of the plan year), or customer election (which can include variations such as termination upon the next billing cycle). Whichever rule is the most lenient will be applied.

Who is covered and when?

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Individual and small group: Beginning on June 1, 2010, well in advance of the Sept. 23, 2010 requirement in the new law, Aetna decided to continue coverage up to age 26, for all dependents currently covered on a parent’s medical plan. The change applied to all existing individual and fully insured small group plans and only impacted those plans in which the dependent limiting age rules were below age 26. Any existing plans with dependent limiting age either at or above age 26 were not impacted by the acceleration of the mandate.

 

www.healthreform.gov

Overview