Expanding ‘Dependent’ Coverage under Health Insurance Plans

March 24th, 2008

According to the U.S. Census Bureau, the fastest growing population of uninsured individuals is young adults – people between the ages of 19 and 34. Most employer-sponsored plans provide that dependents of employees cease eligibility under the parent’s plan as of age 19. Often, dependent eligibility is extended for dependents who are full-time students until the earlier of graduation or some specified age (e.g. age 23).

In order to address this ever-growing uninsured segment, numerous states have enacted or proposed legislation that changes the definition of dependent under health insurance plans. The statutes affecting dependent status vary greatly from state to state. Examples of some of this legislation are:

  • Utah – dependents may not “age-out” until the dependent’s 26th birthday
  • New Jersey – dependents eligible for coverage until the dependent’s 30th birthday (regardless of student status), provided the dependent does not have dependents of his/her own
  • Colorado – dependents are eligible for coverage until the dependent’s 25th birthday (regardless of student status), provided the dependent is unmarried, financially dependent on insurance provider, and shares the same address as insurance provider
  • Connecticut – dependents are eligible for coverage up to age of 26
  • Pennsylvania – full-time students whose studies are interrupted by service in the reserves or the National Guard must be extended health care benefits as a dependent of their parent until they finish school, regardless of their age
  • Delaware – dependents eligible for coverage up to age 24 and premium for over age 18 dependent coverage may not exceed 102% of the under age 18 premium
  • Illinois – dependents called to military active duty between the ages of 19 and 23 remain a dependent (as long as they are a full-time student) after their 23rd birthday for the amount of time they spent serving, with the cut-off age being 25

Employers that have employees in multiple states should consult with benefits counsel to ensure that their employer-sponsored health plan is being administered consistently and in compliance with each state’s mandated dependent coverage provisions. At the same time, other benefits practices that could be impacted by a change in the definition of dependent (such as COBRA administration) should also be reviewed and updated accordingly.

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