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Coverage for Young Adults

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More Minnesota young adults have access to coverage

Under the Affordable Care Act, young adults covered by a parent's health plan can stay on that plan until age 26, even if they are:

• married,
• not living with their parent(s),
• not enrolled in school, or
• no longer financially dependent on their parent(s).

However, if the parent's health plan is grandfathered, the plan does not need to cover young adult children who have group health coverage available through their own employer.

While Minnesota law already required coverage of unmarried kids to age 25, federal health reform:

• extends coverage one more year,
• adds married children, and
• includes plans that were not subject to the Minnesota law (self-insured and out-of-state employers, state employees, etc.)

What are the new requirements under federal health reform for coverage of young adults under a parent’s plan?

The new federal law requires plans that offer dependent coverage to make the coverage available until the adult child reaches the age of 26. 

 

Which plans are required to extend dependent coverage up to age 26?

The expansion of dependent coverage applies to individual family health plans and to new employer plans. It also applies to existing employer plans unless adult children have coverage available through their own employer. Beginning in 2014, children up to age 26 can stay on a parent’s employer plan even if they have another offer of coverage through their own employer.

The federal requirements apply to self-funded employer plans and plans offered by insurance companies in all states. 

Can plans require that my young adult child be a full-time student?

No. Under federal health reform, young adult children do not need to be full-time students to be covered under a parent’s health plan.

What are the new requirements under federal health reform for coverage of young adults under a parent’s plan?
The new federal law requires plans that offer dependent coverage to make the coverage available until the adult child reaches the age of 26.
Which plans are required to extend dependent coverage up to age 26?

The expansion of dependent coverage applies to individual family health plans and to new employer plans. It also applies to existing employer plans unless adult children have coverage available through their own employer. Beginning in 2014, children up to age 26 can stay on a parent’s employer plan even if they have another offer of coverage through their own employer.

The federal requirements apply to self-funded employer plans and plans offered by insurance companies in all states.

Does the adult child have to purchase an individual policy?

No. Eligible adult children who want to take advantage of the new coverage can be included in the parents’ family policy. They do not have to purchase an individual policy.

Are both married and unmarried young adult children covered under the expansion of dependent coverage?

Yes, but plans are only required to provide coverage for the married adult child.  There is no requirement to cover the spouse of the adult child.

 

Can plans require that my young adult child be a full-time student?

No. Under federal health reform, young adult children do not need to be full-time students to be covered under a parent’s health plan.

Does my young adult child have to live with me or be financially dependent on me to be covered under my health plan?

No. Under federal health reform, the parent’s health plan cannot require that the young adult child live with their parent or be financially dependent on the parent to be covered under the parent’s health plan.

Once federal health reform takes full effect in 2014, are there any restrictions on coverage of young adult children under age 26?

Under federal health reform, plans that offer dependent coverage must provide coverage until a child reaches the age of 26. 

There is one exception for group plans in existence on March 23, 2010. Those group plans may exclude adult children who are eligible to enroll in their own employer’s health plan. This exception for adult children ends on the plan’s renewal date in 2014. 

Does federal health reform put any requirements on a plan to cover a grandchild?

No. The federal health reform law does not include any requirements related to coverage of grandchildren.  

However, if a plan is subject to Minnesota law, there are existing requirements for the coverage of grandchildren. Under Minnesota law, health plans must cover grandchildren who are financially dependent on a covered grandparent and reside with that grandparent continuously from birth. 

If a person doesn’t know if their plan is subject to Minnesota law, they can ask their human resources department or the company that processes their health claims. If the plan is self-insured, Minnesota’s law does not apply. 

I am under age 26 and do not have coverage available through my own employer. My parents are covered under separate plans through their employers. Both offer dependent coverage. Can I choose to enroll in either parent’s plan?

Yes, though it does depend on whether the plan is open for adding new dependents.  Plans should have already provided a special enrollment period for young adult children when eligibility expanded for kids to age 26. If a parents’ plan has an open enrollment period, young adult children should be able to enroll at that time. If the young adult child loses other group coverage, they may also be eligible to enroll as a special enrollee. Check with both parents’ plans and find out when and how to enroll.

Does the requirement to cover dependents apply to plans that do not currently provide dependent coverage?

No. There is no federal requirement for a plan to offer dependent coverage. However, the majority of employer-based health plans offer dependent coverage. If coverage is not available through an employer, policies can be purchased directly from a health plan.

 

If a person doesn’t know if their plan is subject to Minnesota law, they can ask their human resources department or the company that processes their health claims. If the plan is self-insured, Minnesota’s law does not apply.

 

My child is disabled. Is there any extension available to keep my disabled child on my plan?

Yes. Under Minnesota law, if a child is incapable of self-sustaining employment because of a developmental disability, mental illness or disorder, or physical disability, their parent may be able to keep the child on their plan. The child must be chiefly dependent upon the parent for support.

 

The parent must notify the insurance company of their child’s disability within 31 days of the child reaching the age that coverage would otherwise terminate under the plan. 

 

The family will be required to provide documentation.

Do all plans that cover Minnesotans have to follow Minnesota law about disabled children?

No. If coverage is through an out-of-state plan or if the employer is self-insured, Minnesota’s law does not apply. If an employee doesn’t know whether their employer is self-insured, they can ask their human resources department or the company that processes their health claims.