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April 12, 2010
Healthcare Reform Update: Dependent Coverage to Age 26

Effective for plan years beginning on or after September 23, 2010, the Patient Protection and Affordable Care Act as amended by the Health Care and Education Reconciliation Act of 2010 requires group health plans and health insurers that offer group or individual coverage that cover dependents to cover dependents on a parents plan until the dependent’s 26th birthday.

For plan years beginning before January 1, 2014, a group health plan that was in existence on March 23, 2010 does not have to make coverage available to an adult child if the child is eligible to enroll in another employer-sponsored group health plan.

There is no requirement to make coverage available to a grandchild even if that child’s parent is covered as a dependent. Regulations are to be issued defining which dependents to whom coverage must be made available because of this requirement. The definitions of a dependent under existing law, however, remain unchanged.

Employers will likely have to cover additional dependents because of this provision. Keeping track of the coverage eligibility of dependents has always been a problem for employers. Employers are advised to obtain all the information needed for determining dependents’ coverage eligibility before this provision impacts their plan and keep it up to date to minimize paying for ineligible dependents.

Many states have existing laws that require insured plans to provide similar or more expansive coverage of dependents. These provisions still apply to insured plans in those states.

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For more information on healthcare reform, visit Healthcare Reform: A Resource Center for Employers on Compensation.BLR.com.

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