<p>Sounds like your plan is grandfathered and not required to keep kids on the plan to age 26 yet. </p>
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<p>All healthcare plans (if large enough to be subject to the rules) must allow dependents to stay on the plan until age 26 (company chooses whether to end at 26th birthday or at end of year in which kid turns 26). Where grandfathering comes in is that a grandfathered plan does not HAVE to allow the dependent to stay on the plan if he/she has health insurance available through his/her employer … some grandfathered plans do choose to allow the dependents to stay on even if they have insurance available, though.</p>
<p>Grandfathered plans are those that keep their plans close to the way they were before the rules kicked in … there are a bunch of rules regarding contributions, deductibles, etc that only your favorite actuary can truly enjoy hearing about. Groups like the idea of staying grandfathered in order to avoid certain rules - like the age 26 one and the fact that they don’t have to develop an expanded appeal process.</p>
<p>Bromfield, it will be a NEW policy, correct? Therefore, it can’t be grandfathered & is bound by the healthcare reform rules. It wouldn’t matter for her, anyway, because she doesn’t have access to her own insurance.</p>
<p>I am not quite sure what “non-group” means, though,and I don’t know the rules for individual policies, if that is what it would be now.</p>
<p>Basically, we have the same type of policy that someone who doesn’t have access to health insurance through his employer would purchase. It was what Blue Cross offered H’s company when they said the company was no longer eligible for group coverage. Does that make sense? The enrollment period was in February and D just got a member card–so it looks like she’s covered.</p>
<p>Bromfield, it sounds like it is an individual plan. Anyone can go to the insurance website and get a quote and sign up for an individual plan. There are no "rules’ for these plans in the context of the health reforms because they are not group plans. Most do follow the unlimited payout and since HIPAA, preexisting conditions can not cause a denial if you haven’t had a gap in coverage.</p>
<p>kelsmom–the other links posted were also government publications for the most part.</p>
<p>again from your link:</p>
<p>Q: Why is there a special exception for group plans in existence on March 23, 2010? </p>
<p>A: Our goal is to cover as many young adults under the age of 26 as possible with the least amount of burden. If a young adult is eligible to purchase other employer-based health insurance such as through her job, the law does not require the parent or parents’ plan to enroll that child if the parents’ plan is a grandfathered health plan (i.e., in existence on March 23, 2010). Of course, all group plans have the option to cover all adult children until the age of 26 or beyond. In 2014, this exception will no longer apply.</p>
<p>^^ True, the carriers can’t outright deny you. But they medically underwrite, which can put the policy so far out of reach financially that it might as well be a denial.</p>
<p>^^depends on where the policy is written–some states forbid medical underwriting and ratings on individual policies…and in 2014 all policies will be like that.</p>
<p>If a young adult is eligible to purchase other employer-based health insurance such as through her job, the law does not require the parent or parents plan to enroll that child if the parents plan is a grandfathered health plan (i.e., in existence on March 23, 2010).*****
That is not the issue in dispute. I already said that.</p>
<p>The issue I am disputing is that some do not have to cover dependents to age 26 AT ALL.</p>
<p>You can write a plan today or in 2016 if you want that says you will only cover employees and you are not subject to having dependents on your plan, at all. Employers are in no way required to provide coverage for non-employees (spouses/children). IF your plan covers dependents (spouse, children) and it is not grandfathered, you have to cover children 26 and younger.</p>
<p>If your plan covers dependents, it must cover those under 26. If the plan is grandfathered, it also must cover those under 26 … UNLESS the dependent has health care available through his/her own employer. It is an important distinction.</p>
<p>My HR site is pretty clear that children 26 and under are covered. BTW, there are some categories of children over 26 covered too. The coverage here is broad with respect to children, broader than what the law requires.</p>
<p>Yes, disabled children over the age of 26 are covered if they were covered by the plan at the time they reached the limiting age. The interesting thing in this case is that while those under 26 get to be covered even if they are married, those over 26 do not. So it is conceivable to have a disabled dependent who loses coverage at 26 because he is married, even if he was married before & was covered.</p>
<p>The definition is generally along the lines of: Eligibility for coverage for a child who is your Dependent continues without limitation if the child is diagnosed as permanently disabled due to a physical or mental condition that initially occurred and was documented before the child reached the age of 26, and the child relies on you for all or most of their support.</p>
<p>The law requires that all dependents under the age of 26 be covered, but it doesn’t stipulate that those over the age of 26 must be covered if married … some companies may allow, others may not. And the determination of disabled would be ultimately made by the insurance company — as they are the ones approving the application.</p>
<p>Thanks, kelsmom! We’re hopeful that our sons won’t be considered permanently disabled (they’re doing well now at 16 and 19), but we have to plan for the worst.</p>
<p>To me, it is always best to get IN WRITING from your OWN carrier what IS and IS NOT covered regarding our “kids.” I was able to get written confirmation that our kiddo who is 24 and has a full-time job that offers GOOD medical insurance remains covered under H’s policy until S turns 26. S has chosen to decline getting his own policy & remain on H’s. He has had claims made under H’s policy paid with no Qs asked, even though he is out of state and financially independent.</p>
<p>I would ask for your customer service department to put in writing what is required for your kiddo to remain covered under your policy due to mental health disability or whatever else you would like to claim. Also start the process well before your kid will age out of the system, so you have time to appeal, as needed.</p>
<p>I agree that it is a good idea to start the process before your child ages out, if you need to keep them on as a disabled dependent. Realize, though, that during the first couple years of the extension, you may be asked to provide proof of continuing disability “at any time,” and thereafter may be asked annually for proof.</p>
<p>Those that had kids on their insurance for college probably had to deal with the verification thing anyways. I got called a few times at work on verification. I just stated that they were full-time college students and that was good enough. They said that they do audits from time to time (I assume a small sample) but we were never asked to provide any proof of enrollment. Keeping them on our insurance saved us about $7K.</p>