Boca Benefits Consulting Group Inc.

Below from The White House Blog. See http://www.whitehouse.gov/blog/2010/04/27/more-support-young-adults for a list of carriers voluntarily accelerating the “age 26” provision to make in coincide with 2010 college graduation dates as of the date of this posting. BBCG expects that most all carriers will ultimately agree to this timeline.

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But we knew that some young adults graduating from college this spring could risk losing their health insurance before the provision takes effect, only to be added back onto their parents’ policy the next time their parents’ plan comes up for renewal on or after September 23rd.  That was bad news for families and bad news for insurance companies too.  Removing an individual from a health insurance plan and then adding them back on a few months later takes time, and it costs money.

That’s why on April 19, Health and Human Services Secretary Kathleen Sebelius called on leading insurance companies to begin covering young adults voluntarily before the September 23 implementation date required by the new health reform law.  Early implementation would avoid gaps in coverage for new college graduates and other young adults and save on insurance company administrative costs of dis-enrolling and re-enrolling them between May 2010 and September 23, 2010.   Early enrollment will also enable young, overwhelmingly healthy people who will not engender large insurance costs to stay in the insurance pool.

And we’re pleased to report that the following insurance companies are doing just that:

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We have received communications from both CIGNA and Aetna that they will each be implementing the “to age 26” provisions of the Patient Protection and Affordable Care Act earlier than required by statute (9/23/2010).  The concern stated is the potential for a gap in coverage for those in the 21-26 age group who may be graduating from college and who would otherwise lose eligibility once full-time student status was eliminated.

Both companies are making their eligibility changes effective 6/1/2010.

Although we have not seen announcements from either Blue Cross/Blue Shield or United Healthcare, BBCG is surmising that the changes announced by Aetna and CIGNA have become the new de facto eligibility standard and that the other major healthcare insurers will follow.

Click here for CIGNA announcement. 

Click here for Aetna announcement.

[Below Excepted from Recent Carrier Communication]

On October 9, 2008, President Bush signed into law H.R. 2851, “Michelle’s Law,” which requires group and individual health plans to continue to cover otherwise eligible dependent children who take a medical leave of absence from a postsecondary educational institution (e.g., a college, university, or vocational school) due to a serious illness or injury.

Key Provisions

The bill applies to both group and individual coverage and amends ERISA, the Public Health Service Act, and the Internal Revenue Code with substantially similar provisions:

• “Dependent child” includes a dependent child who was enrolled in the plan or coverage on the basis of being a student at a postsecondary educational institution immediately before the first day of a medically necessary leave of absence.
• “Medically necessary leave of absence” triggers continued coverage for the dependent child and is defined as a leave of absence – or any other change in enrollment – that begins while a dependent child is suffering from a serious illness or injury that causes the child to lose their student status for purposes of coverage under the plan.
• Physician certification. The bill requires that health plans and insurers receive certification by the dependent child’s treating physician that the dependent child is suffering from a serious illness or injury and that the leave of absence is medically necessary.
• No change in benefits. Dependent children on a medically necessary leave of absence are entitled to receive plan benefits, and if the plan changes, these dependents are entitled to receive benefits as provided by the amended plan until their coverage ends.
• Duration of leave of absence. Dependent children on a leave of absence must be covered until the earlier of one year from the first day of the leave of absence or the date on which the coverage otherwise would terminate.
• Notice. Health plans and insurers must include a description of the requirements for continued coverage during medically necessary leaves of absence with any notice about required certifications of student’s eligibility status.
• Effective Date. Plan years beginning on or after one year from the date of enactment.