SB 70

Current law contains a number of provisions related to coverage of dependents

under health insurance policies. For example, a health insurer must cover a newly

born child of an insured from the moment of birth, but may discontinue coverage

after 60 days if the insured does not notify the insurer of the birth and pay any

additional premium within those 60 days. If a health insurer covers a child of an

insured, the health insurer must also cover any child of the insured's child until the

insured's child is 18 years old. If a health insurer covers dependents up to a certain

age, the health insurer may not terminate coverage of a dependent child who reaches

that age if, and while, the child is incapable of self-sustaining employment because

of mental retardation or physical handicap and is dependent on the insured for

support and maintenance. If a health insurer covers a person as a dependent because

the person is a full-time student, the health insurer must continue to cover that

person if he or she ceases to be a full-time student due to a medically necessary leave

of absence until the happening of one of a number of specified events, such as the

person's obtaining other health care coverage or reaching the age at which coverage

ends under the terms of the policy for a dependent who is covered because he or she

is a full-time student. Current law, however, does not require a health insurer to

cover a dependent of an insured up to any particular age or because a dependent is

a full-time student.

Under this bill, a health insurer must offer to cover any child of an insured if

the child is unmarried, is under 27 years old, and is not eligible for coverage under

a group health benefit plan that is provided by his or her employer and for which his

or her premium contribution is no greater than the premium amount for his or her

dependent coverage under his or her parent's health insurance plan. Additionally,

if the child is a full-time student but previously had his or her education interrupted

by service in the national guard or reserves, the health insurer must offer dependent

coverage for that child for as long as he or she is a full-time student, regardless of

age.

The insurer must provide the coverage if the insured requests it, and may

require that the insured provide annual written documentation that the dependent

child satisfies the criteria for coverage. The bill specifies that an insurer must

determine the premium for coverage of a dependent who is over 18 years of age on

the same basis as the premium is determined for a younger dependent. The coverage

requirement applies to all types of individual and group health insurance policies

and plans, including those offered by the state, and to self-insured health plans of

counties, cities, villages, towns, school districts, and the state.

The bill does not eliminate any of the other requirements that exist in current

law related to coverage of dependents.