Health insurance reform
August 2, 2010 8:12 PM   Subscribe

Aetna recently contacted my parents saying that because they provide less than 50% of my financial support, I am no longer eligible to be a dependent on the family health insurance plan. However, the new legislation passed by Congress seems to say that I can stay on the plan until I am 26. Can anyone clear up this confusion?

I went to the government's site and found this page. The page doesn't mention anything about the child's income excluding him from a parent's plan. Can I remain on my parents' insurance until I'm 26, even if I support myself financially?
posted by Aanidaani to Law & Government (16 answers total) 4 users marked this as a favorite
 
It looks like CNN has some useful information regarding children of parents in health care situations. According to the article, it doesn't start covering children up to 26 until September 23rd of this year.
posted by amiableamy at 8:18 PM on August 2, 2010 [1 favorite]


This question seems relevant, though I am not a lawyer:
Q: Can plans or issuers who offer dependent coverage continue to impose limits on who qualifies based upon financial dependency (emphasis mine), marital status, enrollment in school, residency or other factors?

A: No. Plans and issuers 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 an employer-sponsored health plan, unless it is the group health plan of their parent. This exception is no longer applicable for plan years beginning on or after January 1, 2014.
posted by MegoSteve at 8:19 PM on August 2, 2010 [1 favorite]


Also apparently key is when your plan renews. Last I heard, my plan won't be adding kids over our old age limit till February; that's our open enrollment period.
posted by SMPA at 8:21 PM on August 2, 2010


FWIW, two of my roommates just graduated. One was told by her parents' insurance company that "we don't know so we're just going to have to cut your coverage until Sept. 23" and the other was told "we don't know so we're just going to keep covering you."

So basically whatever your insurance company tells you, you'll have to live with. On preview, actually what MegoSteve said. Just be reeeally careful until that kicks in.
posted by ista at 8:23 PM on August 2, 2010


Amiableamy is correct; that part of the legislation does not go into effect until 9/23/10 of this year. Additionally, if your parent's plan is a "grandfathered" plan, then you still may not be eligible for coverage.

MegoSteve's cite is also correct. Under plans subject to the new legislation, dependents up to age 26 can be covered regardless of marital status, student status, residency, or whether or not the child is a tax dependent per the IRS. The one exception is that children who are eligible for their own employer-sponsored coverage are not eligible dependents per this legislation.

FYI, if it matters, I'm a plan-administrator for a large, self-funded health plan with about 3000 lives.
posted by pecanpies at 8:25 PM on August 2, 2010


See if your state has any laws that supersede the federal coverage. Many do.
posted by gjc at 8:26 PM on August 2, 2010


If it would help, go to your parents Aetna web page (for their state or particular plan) and try searching for "PPACA" updates. Because some aspects of the new rules are still being clarified by the govt in response to insurer questions, many insurers change their info frequently. The person you talked to might not know.

The "grandfathering" aspect is confusing and that's one thing that's being worked out now as well (at least at the Very Large Insurer I work for). What I've been hearing is that the benefit gained from excluding a few people for being between say 22 and 26 (pretty much the cheapest group to insure) is small enough that a lot of plans are unlikely to bother with keeping age restrictions even if they can--because even if they can, the rules seem to say, they would only be able to do so until the next plan year renewal anyway. But that's not a guarantee of course.

So short answer, keep going back for updates, because it may end up just being a minor gap.
posted by emjaybee at 8:40 PM on August 2, 2010


My question is how Aetna knows your parents aren't providing you more than 50% financial support, and if that was a factor in your coverage previously. Was that a requirement when your coverage renewed this year? It's been at least 10 years for me, but all I had to do to stay on my parents insurance (back in the day) is to show that I was enrolled in college. I don't think they can change the coverage in the middle of a plan year (but can make changes effective at the next open enrollment period) so I'd have someone check on what the coverage certificate says. They may be saying this to people before it can legally go into effect in hopes that you won't question it. Insurance companies tend to do that.

I am not in HR or the insurance biz, but I have had to call bullshit on insurance tactics several times in the past. Leave no stone unturned!
posted by MultiFaceted at 10:13 PM on August 2, 2010


Kaiser Health has had some of the most consistently accurate information about the health care reforms. Their factsheet on the extension of dependent coverage is in .pdf form but it's only a couple of pages and can be downloaded at the link below.

http://www.kff.org/healthreform/upload/8065.pdf

The factsheet does discuss the issue of how the new federal regulations will interact with with existing state regulations regarding dependent coverage.
posted by Lolie at 2:18 AM on August 3, 2010


According to the article, it doesn't start covering children up to 26 until September 23rd of this year.

While technically true (and really, they can wait until the next enrollment period), many insurance companies are willing to extend coverage earlier to people in this situation (like myself, yay!). It's probably best if your parents contact their insurance rep through their employer (i.e. HR) and see what can be done here. Insurance companies true customers aren't their members, it's the businesses that buy their coverage, and one can often get better and more accurate service by going through the employer, especially for eligibility type questions.
posted by zachlipton at 2:45 AM on August 3, 2010 [1 favorite]


Additionally, if your parent's plan is a "grandfathered" plan, then you still may not be eligible for coverage.

This is the opposite of true. If your parents' plan is grandfathered (meaning exists as it did on March 23, 2010), you will be eligible. If the plan loses its grandfathered status (that is, the plan makes certain changes to increase costs to participants, eliminates benefits, changes carriers, etc), you are still eligible unless you have other employer based group health coverage (through your job or your spouse's, eg).


See if your state has any laws that supersede the federal coverage. Many do.

State law won't supercede federal law. Generally, if a plan is fully insured (that is, the employer shifts the risk to an insurance carrier), ERISA (or PHSA if it's a government entity such as a school district) and state law will apply. If the plan is self-funded, state law does not apply at all.

The preemption provisions of PPACA provide that state law will apply to the extent that the state law does not "prevent the application" of the federal law. For example, PA has an "under 30" law that requires insurance carriers to offer coverage to employers to cover their employees' dependent children up to age 30 (at the employees' cost). However, the federal age 26 law (PPACA) preempts that state law for dependent children to age 26 (i.e. the employer can't charge the employee extra for those dependents) because the age 30 state law would prevent the application of the age 26 federal law. The state law applies for dependents between age 26 and 30 for fully insured plans in PA.

However, two caveats. The PA state law is voluntary on the part of the employer (insurers must offer, employers don't have to provide to employees) AND the state law applies only to fully insured plans. If the plan is self-insured (the "insurance" card still may say Aetna or CIGNA or BCBS or whatever), the state law doesn't apply at all.
posted by Pax at 5:06 AM on August 3, 2010


Clarification: if the employer is a state or local government entity, the Public Health Service Act applies, but state law only applies where the state has specifically subjected those entities to state law (Florida is the only state I can think of off the top of my head that does this).
posted by Pax at 5:10 AM on August 3, 2010


If the plan loses its grandfathered status (that is, the plan makes certain changes to increase costs to participants, eliminates benefits, changes carriers, etc), you are still eligible unless you have other employer based group health coverage (through your job or your spouse's, eg).

Sorry, I reversed this. I was the opposite of right when I said it was the opposite of true. Maybe I should go back to bed.
posted by Pax at 5:13 AM on August 3, 2010


That's why I said it supersedes coverage, not law.
posted by gjc at 5:46 AM on August 3, 2010


MultiFaceted is very right. How does Aetna know your income? Best advice is to never trust a health insurance company. Aetna, for example, may just be trying to scare you into buying a policy.
posted by justcorbly at 7:29 AM on August 3, 2010


I am an employee benefits attorney, and I do a lot of work related to health care reform lately. I am not your lawyer.

First, Aetna has agreed to HHS's request for insurance companies to adopt dependent care coverage early, so the fact that the effective date for these provisions is the first day of the first plan year after September 23 (for non-calendar year plans) or January 1 (for calendar year plans) shouldn't matter here. See http://www.aetna.com/news/newsReleases/2010/0421_Young_Adults.html, http://www.hhs.gov/ociio/regulations/adult_child_fact_sheet.html.

Second, "dependent child" is kind of a misleading phrase in the Act. According to the interim regulations, for a "dependent child" to be eligible for coverage up to age 26, the child need not be financially dependent on his/her parents, live with his/her parents, be a student, or be employed.

You should appeal this benefits determination. You might want to consider citing the part of the interim regulations restricting the definition of "dependent child." (FYI, that reference would be 26 CFR section 54.9815-2714T.)
posted by mchorn at 4:25 PM on August 3, 2010 [1 favorite]


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