Extended dependent coverage through age 29
Extended Dependent Coverage
The law extending dependent coverage through age 29 has two components: (1) a “make available” rider policyholder option and (2) a mandatory member right of election.
Make Available Option – The law permits group policyholders the option to increase the maximum coverage age for eligible dependents through 29. Beginning with new sales and renewals on and after September 1, 2009, direct pay and group contract holders may extend coverage for their subscribers’ eligible dependents through age 29. This is at the option of the contract-holder and is not mandatory.
If the policyholder chooses this option, the dependent must meet each of the eligibility requirements listed below to qualify for the extended dependent coverage.
The dependent must:
| Be the unmarried child of the employee or member/subscriber insured under the policy,|
| under age 30,|
| not covered by or eligible for employer-sponsored insurance, Medicare, or a self-insured employer plan, and |
| live, work or reside in New York State.|
The coverage for the dependent will be the same that applies to the employee or subscriber under the current group or individual policy and will require payment of an increased premium by the policyholder.
| Group subscribers (members) who want to cover dependents under this option must complete a Member Enrollment Form even if the dependent is already a covered member under the policy. |
Mandatory Right of Election – If the group policy-holder does not buy the “make available” rider described above, the law allows covered employees and their eligible dependents to buy extended coverage through age 29 for their eligible dependents who have “aged-out” under the policy. This right of election became available on September 1, 2009 as contracts are issued or renewed. This COBRA-like right applies to all groups, regardless of size and requires the subscriber to pay the full premium for this extension. The coverage provided to the dependent child will be the same as the coverage provided to the employee/parent.
To be eligible for this continuation rights, a dependent must:
| Be the unmarried child of the employee or member/subscriber insured under the group policy, |
| under age 30,|
| not covered by or eligible for employer-sponsored insurance, or a self-insured employer plan,|
| live, work or reside in New York State or in the plan’s service area. |
The subscriber must complete an Enrollment/Change Form and submit with the first premium check, to his or her employer.
Information on these two new laws is on the New York State Insurance department site at http://www.dfs.ny.gov/insurance/health/S6030_Age29.htm