Topic:
HEALTH INSURANCE; JUVENILES; MARRIAGE (GENERAL);
Location:
INSURANCE - HEALTH; JUVENILES;

OLR Research Report


July 24, 2008

 

2008-R-0426

COVERING STEPCHILDREN UNDER PRIVATE INSURANCE

By: Janet L. Kaminski Leduc, Senior Legislative Attorney

You asked if Connecticut requires health insurers to permit a person insured under a health insurance policy to enroll a stepchild who lives with him or her and, if not, if any states do.

SUMMARY

Connecticut law does not explicitly require health insurers to permit a person insured under a health insurance policy to enroll a stepchild who lives with him or her. But because the Insurance Department interprets the term “child” under the health insurance statutes as including a stepchild, any statute applying to a child also applies to a stepchild.

Under Connecticut law, if a health insurance policy includes coverage for children, then the policy must comply with applicable statutes, including those that establish enrollment eligibility requirements and coverage termination for children, which are described below.

We conducted an electronic search for other states' requirements. Only three specifically include a stepchild in the definition of “child” with respect to health insurance policies: Maine, Maryland, and West Virginia. These states treat a stepchild in the same way as biological children. Additionally, all states require insurers to permit enrollment of a noncustodial child (one not living with the insured parent) as specified in a court or family magistrate order.

CONNECTICUT INSURANCE DEPARTMENT

The Insurance Department does not make a distinction between biological or “by marriage” children when interpreting the state's insurance statutes. Thus, even though the statutes do not specify stepchildren that live with a policyholder or person insured under an insurance certificate, the department interprets any insurance statute that applies to children as also applying to stepchildren.

CONNECTICUT INSURANCE LAW

Termination of Children's Coverage

Until January 1, 2009. Connecticut law prohibits a child's coverage under an individual health insurance policy from ending before the policy anniversary date on or after the date the child (1) marries; (2) is no longer dependent on the policyholder; or (3) turns age 19 or age 23 if a full-time student at an accredited school of higher education, whichever occurs first (CGS 38a-497).

Group comprehensive plans must 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. Group comprehensive care plans must 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 or age 23 if a full-time student at an accredited school of higher education, whichever occurs first (CGS 38a-554).

Effective January 1, 2009. PA 08-147 ( 8 & 9) revises the criteria for determining when a child loses coverage under a private health insurance policy, effective January 1, 2009.

The new law requires individual health insurance policies to continue a child's coverage at least until the policy anniversary date on or after the date the child:

1. marries;

2. ends Connecticut residency, unless he or she is (a) under age 19 or (b) a full-time student at an accredited college;

3. gets coverage under his or her employer's group health plan; or

4. turns age 26.

It requires group comprehensive health care plans to (1) extend coverage eligibility to unmarried children under age 26 and (2) offer continuation coverage to the end of the month in which the child meets the above criteria for losing coverage under an individual policy.

Mentally or Physically Handicapped Children

A health insurance policy must continue covering a child who's coverage would otherwise terminate under the above statutes if the child is (1) mentally or physically handicapped and (2) dependent on the insured parent or guardian for support (CGS 38a-489 and 38a-515).

Newborns and Adopted Children

A health insurance policy that provides coverage for family members must cover injury and sickness, including care and treatment of congenital defects and birth abnormalities, for (1) newborns from birth and (2) adopted children from legal placement for adoption (CGS 38a-490, 38a-508, 38a-516, and 38a-549).

JLK:dw