Notice Required for Dependent Child Health Care Coverage to Age 26

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Interim Final Rules implementing the Patient Protection and Affordable Care Act (Act) require health care issuers to provide written notice of an enrollment opportunity to individuals whose coverage ended, or who was denied coverage (or was not eligible for coverage) under a group health plan because, under the terms of the plan, the availability of dependent coverage of children ended before attainment of age 26.

Such coverage is effective for plan years beginning on or after September 23, 2010 (January 1, 2011 for calendar plan years).

The enrollment opportunity must continue for at least 30-days, regardless of an open enrollment period.

This enrollment opportunity, including the written notice, must be provided not later than the first day of the first plan year beginning on or after September 23, 2010.  Thus, many plans can use their existing annual enrollment periods - which commonly begin and end before the start of the plan year - beginning on or after September 23, 2010, even if the request for enrollment is made after the first day of the plan year.

Written notice can be provided to an employee on behalf of the employee’s child.

Special Exemption for “Grandfathered” Plans

The Act defines a “grandfathered” plan as a group health plan existing as of March 23, 2010.  The Rules provide that a grandfathered plan that makes available dependent coverage of children may exclude an adult child who has not attained age 26 from coverage if the child is eligible to enroll in an employer-sponsored health plan other than a group health care plan of a parent.

Effective January 1, 2014, plans will no longer enjoy grandfathered status.

Grandfathered status is not lost by renewal of the plan or by adding family members of new hires.  Changing carriers or making benefit design changes will result in lost grandfathered status.