You asked for a summary of the private health insurance coverage requirements for children, which the legislature amended in 2007.

SUMMARY

The legislature revised the private health insurance coverage requirements for children in 2007 (See, PA 07-185, §§ 15-17, as amended by PA 07-2, JSS, §§ 64, 65, and 69).

Under the new law, a child's health insurance coverage under an individual policy must continue at least until the policy anniversary date on or after the date the child marries or turns age 26, whichever occurs first. Group comprehensive health care plans must (1) extend coverage eligibility to unmarried children living in Connecticut who are under age 26 and (2) provide the option for a child to continue coverage to the end of the month following the month in which the child marries or turns age 26. For individual policies and continued coverage under a group comprehensive plan, the child must live in Connecticut or, if residing out-of state, must do so (1) as a full-time student at an accredited school of higher education or (2) with a custodial parent pursuant to a child custody determination. The law eliminates the requirement that the child be dependent on the policyholder or covered employee.

The new requirements are effective January 1, 2009.

INDIVIDUAL HEALTH INSURANCE POLICY

New Law

Under the new law, a child's coverage under an individual health insurance policy is prohibited from ending before the policy anniversary date on or after the date the child marries or turns age 26, whichever occurs first.

To be eligible for coverage, the child must live in Connecticut or, if residing out-of state, must do so (1) as a full-time student at an accredited school of higher education or (2) with a custodial parent pursuant to a child custody determination.

The law is effective January 1, 2009. It applies to individual health insurance policies delivered, issued, amended, or renewed on or after that date that cover:

1. basic hospital and medical surgical expenses,

2. major medical expenses,

3. accidents,

4. limited benefits, and

5. hospital or medical services, including HMO contracts.

Prior Law

Under prior the law, which remains effective until January 1, 2009, a child's coverage under an individual policy is prohibited from ending before the policy anniversary date on or after whichever occurs first: the date the child (1) marries, (2) is no longer dependent on the policyholder, or (3) turns age 19 or, if a full-time student in an accredited school of higher education, age 23.

GROUP COMPREHENSIVE HEALTH CARE PLAN

A “group comprehensive health care plan” is a plan that each group health insurance carrier (i. e. , insurance company, HMO, hospital or medical service corporation, and fraternal benefit society) must offer in the state. It must contain certain minimum standard benefits set in law, including coverage continuation rights (CGS § 38a-551, et seq. ).

New Law

Under the new law, the people eligible for coverage under a group comprehensive plan must include an eligible employee's unmarried children who are under age 26 and living in Connecticut.

Additionally, the plan must offer a child the option to continue coverage to the end of the month following the month in which the child marries or turns age 26, provided the child lives in state or, if residing out-of-state, is doing so (1) as a full-time student at an out-of-state accredited school of higher education or (2) with a custodial parent pursuant to a child custody determination. (By law, a child choosing to continue coverage may be required to pay up to 102% of the entire premium at the group rate. )

The law is effective January 1, 2009.

Prior Law

The prior law, which remains effective until January 1, 2009, requires group comprehensive plans to extend eligibility to each eligible employee's dependent unmarried children who are under age 19, or, for full-time students at accredited schools of higher education, under age 23 (CGS § 38a-554(a)).

It also requires the plan to offer a child the option to continue coverage until the end of the month following the month in which the child (1) marries, (2) ceases to be dependent on the employee, or (3) turns age 19, whichever occurs first, except that if the child is a full-time student at an accredited school of higher education, the coverage may be continued while the child remains unmarried and a full-time student, but not beyond the month following the month in which the child turns age 23 (CGS § 38a-554(b)(5)).

JLK: ts