Insurance Insights

By Joe Giangola

One of the first provisions of The Patient Protection and Affordable Care Act to take effect is the extension of coverage to dependents up to the age of 26. This provision will allow children to remain on their parents plan in hopes to cut down on one of the biggest segment of the uninsured - young adults.

The law will effect group plans as well as individual policies on the next plan anniversary after 9/23/10.  Dependents are NOT required to live with their parents and do NOT have to qualify as dependent on their parents income taxes.  The student requirement has also been eliminated.  You can cover your child whether they are married or single but that coverage does NOT extend to your child's spouse or children.

Children become ineligible for coverage under their parents plan once they become eligible for their own coverage through their employer.

The law also states that employers cannot charge a premium for the coverage unless adding the dependent causes a change in the rating class.  For example if the parent already has children coverage and this additional child does not change the premium charged by the insurer, then there is no additional cost to the employee.

If the dependent is over 19 and has not been covered for the last 63 days then a pre-existing condition waiting period of 12 months may be applied.

Ohio HB 1

Ohio allows for coverage to age 28 after the federal eligibility has been exhausted.   However the rules are somewhat different.

To receive benefits up to age 28, the unmarried child must be: 1) the natural child, stepchild, adopted child of the employee; 2) a resident of Ohio or a full-time student at an accredited public or private institution of higher education; 3) not employed by an employer that offers any health benefit plan under which the child is eligible for coverage, and 4) not eligible for coverage under Medicare or Medicaid.

Both of these provisions should go along way in reducing the number of uninsured young adults.