Health care reform requires group health insurance plans that cover an employee’s children to extend eligibility to children up to their 26th birthday.

Here are some highlights:

If your health plan currently offers coverage to your children, that coverage must be extended to them until their 26th birthday – even if they’re attending school or married.

If your plan doesn’t already offer to cover your children, then it still won’t be required to cover your children.

If your plan charges an additional premium for children currently, then the plan can charge an additional premium for adult children added because of health care reform.

Limited-scope dental and vision plans are an exception. Coverage doesn’t have to be offered to children up to age 26 – unless limited-scope dental and vision plans have been bargained into the contract. In that case, those benefits may be extended depending on the contract language.

Below is a fact sheet that should answer many of your questions about insuring your child up to age 26.

Who is eligible?

• Any children up to their 26th birthday who aren’t eligible for employer- or union-sponsored coverage through their job (or through their spouse’s job) are eligible. The plan may not restrict eligibility for coverage based on

• Marital status
• Financial dependency (upon employee or anyone else)
• Residency with the employee or anyone else
• Student status
• Employment
• Any combination of these or other factors (other than age 26)

• Coverage does not have to be extended to grandchildren, children of domestic partners or children over which the participant has legal guardianship up to age 26 -- unless these children are covered under the current plan.
• If both parents have employer- or union-sponsored coverage that covers children, both plans must offer coverage to their children.

How much will it cost?

• The plan can’t charge more for children based on their age or provide different coverage for children based on age. The plan must:

• Offer the same benefits/same price, up to age 26
• Not make additional charges based on age
• Not restrict benefit options available

• The plan can charge more based on the number of children covered, regardless of age. For example, if the plan charges one rate for the employee only, another rate for employee and spouse, another rate for employee and one child, another rate for employee and two children, then it can charge the additional rate for the additional child according to the current plan design.
• The plan can increase costs overall to pay for the cost of covering children up to age 26 if they expect their costs for this coverage will increase. (The government estimates the overall cost increase will be less than one percent.)
• Some plans may change the way they charge premiums as a result of covering adult children For example, they may charge per dependent, regardless of age. However, such changes can’t be made to collectively bargained coverage until the next contract is bargained.
• If you are in a state in which coverage must be extended beyond age 26, the health care reform law doesn’t change that. The age 26 rule is a federal minimum standard. States can choose to extend coverage beyond age 26. However, some employer- and union-sponsored plans are exempt from these state laws because they cover employees in many states.

How Do I Enroll?
Plans must have a special open enrollment period during which children under age 26 can enroll, including children who previously lost coverage, children with COBRA coverage and children denied coverage due to age.

• Employers must give written notice and allow employee-parents at least 30 days to enroll their children in any plan or benefit for which they are eligible.
• Special enrollment right extends to the employee-parent.
• Coverage is effective the first day of the first plan year on or after Sept. 23, 2010 (generally Jan. 1, 2011) if the plan does not adopt this change earlier
• The plan must provide written notice of the opportunity to enroll not later than the first day of the plan year on or after Sept. 23, 2010. That notice

- May be provided to employee on behalf of child;
- May be included with open enrollment materials, if it’s prominent.

If a plan does not extend coverage until required, graduating students do still have the option of COBRA until the new law takes effect for the plan.

If you want to add your child between 21 and 26 to your health plan, this is what you should do:

1. Find out if your plan covers dependants and if it costs more to add dependents.

2. Find out if your child has access to his or her own employer-sponsored health insurance.

3. Find out when the special enrollment period will begin. It will probably begin before the eligibility date so coverage can begin on either Oct. 1, 2010, or Jan. 1, 2011 (if it’s a calendar year plan). Your plan should provide you with written notice before the period begins explaining what your child is eligible for, any costs associated with the coverage and how to enroll.

4. Find out what your plan needs for you to enroll your child – for example, birth certificate or proof of parentage – and collect those documents.

5. Enroll your child as soon as the open enrollment period begins.