Self-insurers governed by federal law, not state law

New York employers who purchase group health insurance

New York employers who purchase group health insurance must make extended dependent coverage available to their employees. (Credit: iStock)

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You recently wrote about the health insurance options available to a young adult who'll lose her coverage in her mother's group plan when she turns 26. Doesn't New York law require group health insurance plans to cover dependents through age 29?

 

You're right that state law requires all group health insurance plans sold in New York to make coverage available to policyholders' dependents through age 29.


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But that law doesn't apply to many big employers because they self-

insure rather than buying insurance. Self-insurers are governed by federal law, not state law. My earlier columns addressed a question from a reader whose employer isn't subject to the New York law.

An employer that is subject to that law can satisfy its requirements either by 1) including extended dependent coverage in the group plan, so that the cost of covering young adults through age 29 is spread among all employees who elect dependent coverage; or 2) by making extended coverage available only on request, so that its cost is paid only by the employees who request it. In that case, extended young adult coverage becomes similar to COBRA. COBRA gives people who are insured in an employer-sponsored group plan the right to continue buying insurance in the plan, even after they've otherwise lost their eligibility for coverage.

If your employer is subject to state law, your child qualifies for extended coverage even if she doesn't live with you and isn't financially dependent on you, provided she is unmarried, younger than 30, not covered by or eligible for employer-sponsored coverage or a self-insured employer plan, and lives and works in New York State or in the plan's service area.

The bottom line New York employers who purchase group health insurance must make extended dependent coverage available to their employees.

Websites with more information nwsdy.li/1pWyiCP and nwsdy.li/1s0DqYG

TO ASK THE EXPERT Send questions to Ask the Expert/Act 2, Newsday Newsroom, 235 Pinelawn Rd., Melville, NY 11747-4226, or email act2@newsday.com. Include your name, address and phone number. Questions can be answered only in this column. Advice is offered as general guidance. Check with your own advisers for your specific needs.

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