TITLE 27
Insurance
CHAPTER 27-18
Accident and Sickness Insurance Policies
SECTION 27-18-59
§ 27-18-59 Eligibility for children's
benefits.
(a)(1) Every health benefit plan delivered, issued for delivery, or renewed in
this state and every group health insurance contract, plan, or policy
delivered, issued for delivery or renewed in this state which provides health
benefits coverage for dependents, except for supplemental policies which only
provide coverage for specified diseases and other supplemental policies, shall
make coverage available for children until attainment of twenty-six (26) years
of age, and an unmarried child of any age who is financially dependent upon the
parent and medically determined to have a physical or mental impairment which
can be expected to result in death or which has lasted or can be expected to
last for a continuous period of not less than twelve (12) months.
(2) With respect to a child who has not attained twenty-six
(26) years of age, a health insurance carrier shall not define "dependent" for
purposes of eligibility for dependent coverage of children other than the terms
of a relationship between a child and the plan participant, or subscriber.
(3) A health insurance carrier shall not deny or restrict
coverage for a child who has not attained twenty-six (26) years of age based on
the presence or absence of the child's financial dependency upon the
participant, primary subscriber or any other person, residency with the
participant and in the individual market the primary subscriber, or with any
other person, marital status, student status, employment or any combination of
those factors. A health carrier shall not deny or restrict coverage of a child
based on eligibility for other coverage, except as provided in subparagraph
(b)(1) of this section.
(4) Nothing in this section shall be construed to require a
health insurance carrier to make coverage available for the child of a child
receiving dependent coverage, unless the grandparent becomes the legal guardian
or adoptive parent of that grandchild.
(5) The terms of coverage in a health benefit plan offered by
a health insurance carrier providing dependent coverage of children cannot vary
based on age except for children who are twenty-six (26) years of age or older.
(b)(1) For plan years beginning before January 1, 2014, a
health insurance carrier providing group health insurance coverage that is a
grandfathered health plan and makes available dependent coverage of children
may exclude an adult child who has not attained twenty-six (26) years of age
from coverage only if the adult child is eligible to enroll in an eligible
employer-sponsored health benefit plan, as defined in section 5000A(f)(2) of
the federal Internal Revenue Code, other than the group health plan of a parent.
(2) For plan years, beginning on or after January 1, 2014, a
health insurance carrier providing group health insurance coverage that is a
grandfathered health plan shall comply with the requirements of subsections (a)
through (e) of this section.
(c) This section does not apply to insurance coverage
providing benefits for: (1) hospital confinement indemnity; (2) disability
income; (3) accident only; (4) long term care; (5) Medicare supplement; (6)
limited benefit health; (7) specified diseased indemnity; or (8) sickness or
bodily injury or death by accident or both; or (9) other limited benefit
policies.
History of Section.
(P.L. 2000, ch. 214, § 1; P.L. 2002, ch. 292, § 33; P.L. 2006, ch.
377, § 2; P.L. 2006, ch. 469, § 2; P.L. 2012, ch. 256, § 3; P.L.
2012, ch. 262, § 3.)
