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May 5, 2010
Fact Sheet
Early Implementation of Dependent Coverage to Age 26
To help our members who have dependents who are graduating from high school or college this spring and may be “aging off” their parent’s
policy, Arkansas Blue Cross and Blue Shield is providing early implementation of the health insurance reform law requirement that
insurance companies cover dependents to age 26. Health insurance reform, or the Patient Protection and Affordable Care Act (PPACA), was
signed into law on March 23. Arkansas Blue Cross will implement this requirement for fully insured group plans and individual
policies effective June 1, 2010.
Along with 38 other independent Blue plans, Arkansas Blue Cross is doing so at the request of the U.S. Secretary of Health and Human
Services to prevent a disruption of services to our members who have graduating students.
Individual or Family Plans
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Dependents who are currently enrolled on their parent’s coverage (regardless of carrier) as of May 31, 2010, will be allowed to
remain on that coverage as long as they are under age 26. Dependents are eligible regardless of student or marital status. Dependents
also are eligible regardless of whether they are claimed as a dependent on their parent’s tax return.
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There will be no rate impact on this change until renewal on plans already in place as of May 15 or before. However, a premium must
be paid to cover the cost of the dependent.
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Those dependents who are under age 26 and who lost eligibility for dependent coverage earlier, can be added back to the plan at the
effective date of the regulation, which is Oct. 1, 2010.
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Standard pre-existing condition waiting periods will apply.
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To allow for administration of this provision, the “group level” information will show 26/26 for dependent coverage effective June 1
for those dependents covered as of May 31.
Frequently Asked Questions (if you have an individual or family policy)
1) Why can’t my child be eligible for coverage June 1?
Health plans were asked by the Secretary of Health and Human Services to implement this provision early so that those who are graduating in
May would not lose coverage only to regain it a few months later. The law will be fully implemented for all dependents who meet the age
requirement by October 1. Your child will be able to apply for coverage in September for an October 1 effective date. In other words, your dependent’s health condition will be considered in determining whether he
or she is eligible for coverage.
2) Does this change apply to all individual policies? Does it apply to mine?
The change applies to your policy if your dependent was covered under your health plan as of May 31, 2010, and has not had a break in coverage.
3) How will I know when the new reform law causes there to be changes to my policy?
We will keep you informed. You will find information on our Web sites and in our member magazine Blue & You. And,
you will receive special mailings from us when your policy is affected.
Employees of Fully Insured Large Employer Groups
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Dependents who are currently enrolled on their parent’s coverage (regardless of carrier) as of May 31, 2010, will be allowed to remain on that
coverage as long as they are under age 26 and not eligible for coverage under another employer’s plan. Dependents who were enrolled on their
parent’s plan are eligible regardless of student or marital status. Dependents also are eligible regardless of whether they are claimed as a
dependent on their parent’s tax return.
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Plans in place prior to March 23, 2010 only have to offer dependent to age 26 coverage if the dependent is not eligible for coverage under
another employer’s health plan.
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Dependents who are under the age of 26 and who were not covered under their parent’s plan as of May 31, 2010 (lost eligibility for dependent
coverage earlier), can be added back to the plan at the effective date of the regulation, which is the first renewal date beginning Oct. 1, 2010 or after.
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Plans in place prior to March 23, 2010 only have to offer dependent to age 26 coverage if the dependent is not eligible for coverage
under another employer’s health plan.
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There is no premium rate impact until the group’s renewal. However, a dependent premium will continue to be charged.
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If the current plan covers dependents to age 27, the change does not impact their plan.
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Standard pre-existing condition waiting periods will apply.
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Although this change will be made automatically, employer groups may choose to “opt out.”
Employees of Small Groups
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Dependents who are currently enrolled on their parent’s coverage (regardless of carrier) as of May 31, 2010, will be allowed to remain on
that coverage as long as they are under age 26 and not eligible for coverage under another employer’s plan. Dependents who were enrolled on
their parent’s plan are eligible regardless of student or marital status. Dependents also are eligible regardless of whether they are claimed
as a dependent on their parent’s tax return.
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Plans in place prior to March 23, 2010 only have to offer dependent to age 26 coverage if the dependent is not eligible for coverage under another employer’s health plan.
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Dependents who are under the age of 26 and who were not covered under their parent’s plan as of May 31, 2010 (lost eligibility for dependent coverage earlier), can be added back to the plan at the effective date of the regulation, which is the first renewal date beginning Oct. 1, 2010 or after.
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Plans in place prior to March 23, 2010 only have to offer dependent to age 26 coverage if the dependent is not eligible for coverage under another employer’s health plan.
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There is no premium rate impact until the group’s renewal. However, a dependent premium will continue to be charged.
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Standard pre-existing condition waiting periods will apply.
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Although this change will be made automatically, employer groups may choose to “opt out.”
Employees of Self Insured Groups
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The employers will make the decision. Employers are being notified of the industry trend of early implementation.
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Without early implementation the increase in dependent to age 26 would take effect with renewals.
Employees with a group dental plan
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Dependent rules are the same as for the fully insured group health plan.
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There is no premium rate impact until the group’s renewal. However, a dependent premium will be charged.
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Standard pre-existing condition waiting periods will apply.
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Dependents who are age 19 and aging off their parent’s plan can apply for an individual policy.
Dental Plans for Individuals and Families
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Dependents who are age 19 and aging off their parent’s plan can apply for an individual policy.
FEP
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This change does not impact FEP members until Jan. 1, 2011.
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