AIM has confirmed with the state Division of Insurance that group health plans purchased from Massachusetts carriers must cover employees’ dependent children up to age 26 - even if the health plan is “grandfathered” under federal health care reform.
The federal reform law contains a dependent eligibility provision that is similar, but not identical, to one that became effective on January 1, 2007 under the Massachusetts reform. The federal rule covers all group plans, both self-funded and fully insured, and is effective with plan years that begin on or after September 23, 2010. It requires coverage up to the 26th birthday. There is a special consideration for “grandfathered” status, allowing such plans to deny coverage, through 2013 only, to adult children who have access to coverage through their own employers.
AIM staff identified a provision in Massachusetts Division of Insurance (DOI) Bulletin 2008-01 stating that, “Carriers may not impose any limitations on eligibility for dependent coverage, other than limitations defining familial relationships under the policy . . . and any other limitations that may be permitted under the (Massachusetts reform law).” That language would make the state rule potentially more favorable to the dependent and take precedence over the federal provision for grandfathered plans.
Representatives from the DOI have responded to AIM’s inquiry and confirmed that consideration of the availability of other coverage is not permitted under Massachusetts insurance law.
The bottom line for Massachusetts-insured employers for plan years beginning on or after September 23, 2010:
- Dependents must be offered coverage up to their 26th birthday - period. There is no longer any consideration of parental support and, as of April 1, 2010, no imputed income application.
- This applies to both grandfathered and non-grandfathered plans.
Please note that this information applies only to group health insurance plans purchased from Massachusetts carriers. It does not apply to “grandfathered” plans that are either self-funded or that are purchased in other states.
Stay informed about the evolving world of health care reform by signing up for AIM’s biweekly Health Reform Fridays webinar series starting September 17, 2010. Contact Melissa Daly at firstname.lastname@example.org for more information on these programs.