Health reform at 6 months: Eligibility for dependent coverage extends to age 26

National health reform turns six months old on Sept. 23, when a variety of new rules and regulations take effect. In this weeklong series, we highlight how benefits will change for consumers in the near term. You can also find videos, news alerts, RSS feeds and other information at our health reform website.

With health care reform approaching the key six-month milestone, we’re reminding people that employers and health insurers will be extending coverage to dependents up to age 26 during a special enrollment period this fall.

Blue Cross first announced an agreement in April between the federal government and health carriers regarding the continuation of dependent coverage to age 26. Starting Sept. 23, the provision will apply to nearly all group and individual health plans.

Previously, dependents over the age of 18 often could only be kept on their parents’ policies so long as they were in college and not married. The new reform law loosens these restrictions.

Under the new rule, employers that offer dependent coverage must extend coverage to their employees’ dependent children who are under age 26, even if they are eligible for employer-sponsored group coverage through work. The same goes for insurers offering dependent coverage to those enrolled in plans in the individual market.

Dependents under age 26 whose coverage previously ended when they reached an eligibility threshold must also be offered the chance to re-enroll.

The rule does not kick in until 2014 for grandfathered group plans where the adult child is eligible for other employer-sponsored coverage. You can read more about grandfathered group plan exceptions and other details of the rule here.

Adult children who need to enroll must be given 30 days to enroll regardless of whether the plan or coverage offers an open enrollment period during that time.

BCBSM and Blue Care Network will hold its special enrollment periods for adult children from Nov. 1 through Nov. 30. The coverage effective date for enrollment is Jan. 1, 2011, with the exception of groups that have a plan year that begins between Sept. 23 and Dec. 31, 2010. In this case, the coverage effective date is the plan year start date.

Groups that routinely offer open enrollment from Oct. 1 through Dec. 31 may use this period to enroll those impacted by this provision, provided it is at least 30 days in duration.

About Shannon Paul
Social Media Strategist at Fifth Third Bank. This is a personal profile. Comments and activity are personal and do not represent my employer.

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