For plan years starting six months after ACA’s enactment (i.e., Sept. 23, 2010), all plans providing dependent coverage are required to make that coverage available to adult children — both married and unmarried — up to age 26. Until 2014, grandfathered group plans are not required to offer coverage to dependents who are eligible for employer coverage other than through their parent.
Both married and unmarried dependents qualify for this dependent coverage. Coverage of the dependent’s spouse or children is not required.
This provision applies to both new and grandfathered plans. However, for plan years before January 1, 2014, grandfathered group health plans may exclude an adult child if the adult child is eligible to enroll in an employer-sponsored health plan other than a group health plan of a parent.* Beginning in 2014, grandfathered group plans must comply with the requirement and children up to age 26 can stay on their parents’ employer plan even if they have other employer-sponsored coverage available.
* Verification of whether an adult child on a grandfathered plan is eligible to enroll in an employer-sponsored health plan other than a group health plan of a parent is considered a complex eligibility scenario/rule that the employer is required to enforce and administer.
No. ACA does not require employers to offer dependent coverage.
ACA specifies that the coverage must continue until the dependent’s 26th birthday. Aetna will administer by using either:
Whichever rule is the most generous will be applied.
For individual policies and small group plans:
For Insured large group and self-funded plans:
The NAIC rules for order of benefit determination are applied to determine which of the plans should be the primary payer.
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