TITLE 27
Insurance
CHAPTER 27-20
Nonprofit Medical Service Corporations
SECTION 27-20-45
§ 27-20-45 Eligibility for children's
benefits.
(a)(1) Every health benefit plan 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 nonprofit medical service corporation 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 nonprofit medical service corporation 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 nonprofit medical service corporation shall not deny or
restrict coverage of a child based on eligibility for other coverage, except as
provided in (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 nonprofit medical service corporation or 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
group health plan 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 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) other limited
benefit policies.
History of Section.
(P.L. 2000, ch. 214, § 3; P.L. 2002, ch. 292, § 39; P.L. 2006, ch.
377, § 4; P.L. 2006, ch. 469, § 4; P.L. 2012, ch. 256, § 7; P.L.
2012, ch. 262, § 7.)
