§27-41-61  Eligibility for children's benefits. –


Published: 2015

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TITLE 27

Insurance

CHAPTER 27-41

Health Maintenance Organizations

SECTION 27-41-61



   § 27-41-61  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 health maintenance organization 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 maintenance organization 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 (b)(1) of this

section.



   (4) Nothing in this section shall be construed to require a

health maintenance organization 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 maintenance organization 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

group health plan 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, § 6; P.L. 2006, ch. 377, § 5; P.L. 2006, ch.

469, § 5; P.L. 2012, ch. 256, § 9; P.L. 2012, ch. 262, §

9.)

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