Common Questions under the Health Care Reform Law – Part 9

Larry Grudzien

February 22, 2011

My client sponsors a grandfathered insured group health plan under a contract written in the State of Illinois. If one my client’s employees wants to cover his or her a unmarried adult child, under age 26, who has access to other group coverage, can my client prohibit the employee from covering him or her because of such access to other coverage?  Would the answer be different if the adult child is married?

No.  The Health Care and Education Reconciliation Act (“HCERA”) Pub. L. No. 111-152, § 2301(a) (2010), amending the Patient Protection and Affordable Care Act (“PPACA”) Pub. L. No. 111-148, § 1251(a) (2010) provides a transitional rule that applies prior to 2014 for grandfathered plans only, allowing coverage to be terminated if a child is eligible for employment-based coverage from another source (other than coverage as a dependent child).

But, the Illinois Department of Insurance indicates that  grandfathered group plans that are subject to the Illinois Young Adult Dependent Coverage Law may not exclude young adults merely because they are eligible to purchase other employer based health insurance. Such plans may, however, require young adults who are eligible for other employer based coverage to be unmarried and to meet other eligibility requirements, not prohibited by the Illinois Law.

Such other eligibility requirements include requiring the young adult to have the same permanent mailing address as the parent) provided that those requirements do not act as a substitute for age or student status.

Since the Illinois requirements do not apply if the adult child is married, the employer can bar the employee from adding the adult child if he or she is married and has access to other coverage.

If you would like to view the Illinois Insurance Facts discussing Adult Dependent Coverage, please click on the link below:
http://www.insurance.illinois.gov/healthinsurance/ya_dependent.asp


For More Information:

If you have any comments or questions regarding any of the above information, please do not hesitate to call (708) 717-9638 or e-mail  Common Questions under the Health Care Reform Law   Part 9

Thank you,

Larry Grudzien

Attorney-At-Law