Health Insurance Coverage for Unmarried Young Adults through Age 29
WHO IS ELIGIBLE?
To qualify for this option, young adults must fulfill the following criteria:
- a child of an employee or other group member insured under a group health insurance policy
- age 29 or younger
- unmarried
- not be insured by or eligible for coverage through the young adult's own employer-sponsored
group policy or contract
- work or reside in New York State or the service area of the insurer's network-based policy
- not covered under Medicare
The young adult does not need to:
- live with the parent
- be a student
- be financially dependent upon the parent
If the young adult qualifies for the option and are also eligible through a former employer for
COBRA, the young adult may still elect the young adult option.
YOUNG ADULT OPTION VS. MAKE AVAILABLE OPTION
YOUNG ADULT OPTION
WHAT IS IT?
Young adults who no longer are eligible to be a dependent under his/her parent's insurance plan can
purchase coverage through the parent's group policy.
- This option is effective upon the employer's renewal (i.e. if the employer renews their
insurance on January 1, then this option becomes effective on January 1, 2010).
- The young adult option requires that a separate premium be paid (either the young adult or the
young adult's parent can pay).
- The parent needs to have active coverage with their employer upon the renewal date in order
to be eligible for the young adult option.
- A parent does not need to have family coverage (the parent can have single or double coverage)
for the young adult to take advantage of the option.
The young adult is entitled to the same coverage that is provided to the parent (even if the
employer offers more than one choice of coverage) and is subject to all the terms and
conditions of the group policy. If the group policy should change, the same new coverage shall
be issued to the young adult.
HOW CAN THE YOUNG ADULT OBTAIN COVERAGE?
- The parent or the young adult may elect the young adult option
- The young adult must complete an enrollment application
WHEN CAN THE YOUNG ADULT OBTAIN COVERAGE?
- When the young adult would otherwise lose coverage due to age
- When a change in circumstances newly qualifies the young adult for coverage
- During the annual 30-day open enrollment period
- During the 12-month open enrollment period after renewal
HOW ARE EMPLOYEES NOTIFIED?
- Carriers must provide to all group members written notice of the young adult option and the
period during which the parent or young adult may elect the option.
- Carriers must also provide notice to group members at least 60 days prior to the date their
dependents will lose eligibility for group coverage due to age.
MAKE AVAILABLE OPTION
WHAT IS IT?
Employers must make coverage available for qualifying young adults through age 29 as dependents
under family coverage.
- Employers have the choice to make this option available on their policy and all employees who
are insured with family coverage receive the option
- The cost for the coverage is spread among all those employees with family coverage (not just
those with eligible young adults) thus included in the current rate for a family plan.
- This option is effective upon the employer's renewal (i.e. if the employer renews their
insurance on January 1, then this option becomes effective on January 1, 2010).
- If this option is made available, there is no special enrollment. The young adult is a dependent
on the parent's policy and if eligible, remains a dependent until 29.
HOW ARE EMPLOYEES NOTIFIED?
- Carrier must provide written notice of the make available option to the policy holder prior to the
inception of the group policy or contract and annually thereafter prior to the policy or contract's
anniversary or renewal date.
