Coverage for Adult Children Ages 19-29: What You Need to Know
Think your adult child is too old to be covered under your policy? Maybe not. Both the federal health reform law (the Affordable Care Act) and New York State’s “Age 29” law may offer ways for your adult child to stay on your plan.
Below are questions and answers that should help you see if your child by birth, adoption or legal guardianship can keep coverage and for how long:
1. How has coverage for adult children changed because of the federal health reform law?
Under the federal health reform law, adult children may stay on or be added to their parent's policy until age 26. Your child does not have be a student or depend on you for financial support.
2. Does everyone get the coverage extension for adult children under health reform?
No, there are some rules. For example: This coverage becomes available when plans issue or renew on or after September 23, 2010. Also, if your child is working, can get insurance through their job and if you have insurance under a group health plan in effect on March 23, 2010 (a grandfathered plan), your child may not be eligible.
Talk to your benefits manager or call the number on the back of your ID card for more information.
3. How do I get the health reform coverage extension for my adult child?
If your adult child is already on your policy and meets all of the requirements explained above and if your policy was issued or renewed on or after September 23, 2010, do nothing. Your child will automatically remain on the policy. You don't need to sign up.
If your child is not currently on your plan, you must wait for the annual open enrollment period to add him or her to your plan. This usually happens on the policy renewal date; check with your benefits manager.
Extended coverage under the federal health reform law runs until the end of the month of your child's 26th birthday. You will receive notice from us about extended coverage under the health reform law and other new benefit changes when your plan renews.
If you have a direct pay policy and would like more information about age 26 coverage, call the Customer Service number on the back of your ID card.
NOTE: If your benefit plan already provides dependent coverage through age 29, that coverage will remain in effect unless you or your group drops this coverage rider.
4. What about the benefits extension under New York State law?
The New York State “Age 29” law may allow your child to have coverage under your health plan until the end of the month of their 30th birthday. Your child does not need to live with you, be a student or depend upon you financially. And if your child previously lost benefits because they reached your plan’s age limit, he or she may be able to re-enroll.
There are eligibility rules for extended coverage under the “Age 29” law. Your child cannot be:
- Older than 29 years of age.
- Insured by or eligible for health benefits through their own employer.
- Living or working outside of New York or our service area.
- Covered by Medicare.
5. How can we get the “Age 29” extended coverage?
Groups may purchase a rider that would allow the children of employees to receive “Age 29” coverage under the group plan.
Individual direct payment policyholders may also purchase this type of rider, but generally only at the start of the coverage.
If you are covered under a group policy and your group has not purchased this rider, you or your child can buy “Young Adult Option coverage“ on your own.
6. What do we have to do to get the Young Adult Option coverage?
Either you or the child can enroll the child in coverage. You can do this at the following times:
- Within 60 days of the date your child would age out of the coverage under your group health plan. At least 60 days before the child's coverage is set to end, you will receive a letter about Young Adult Option coverage from us. The letter will give you instructions on how to apply for coverage.
If you think your child is eligible but you did not get a letter from us, contact your benefits manager to find out if your employer bought the Age 29 rider. If not, ask your employer or contact us about the Young Adult Option coverage.
- Within 60 days of a change in your child’s eligibility. If your child was not eligible for Young Adult Option coverage, but circumstances change so that the eligibility requirements are now met, he or she can be added to your plan within 60 days of the change. For example: A change in circumstances occurs when a child who was not eligible for age 29 coverage because he or she lived outside of New York State moves back to New York State. In this case, the child must be signed up within 60 days of moving back to New York State.
- During your group health plan's annual open enrollment period. Coverage will begin within 30 days of your employer or group administrator's receipt of notice of your election, as well as your premium payment. You can also enroll eligible children at any time during a special initial 12–month open enrollment period that begins on the first renewal of the group health plan on or after September 1, 2009.
Note: The Young Adult Option coverage is not available to direct payment policyholders. If you have a direct pay policy, call the Customer Service number on the back of your ID card for more information.
One last thing you need to know: Adding anyone to your policy and making changes to your plan type (from single to parent/child or from husband/wife to family, etc.) may change your premium. Talk to your benefits/HR manager for details on how any change may impact your out-of-pocket expenses.
If you have questions about your specific plan, please call the number on the back of your ID card. Members can also log on to myEmblemHealth and register for information on eligibility, claims, benefits and much more.