From time to time, the Help Wanted column focuses on a single topic. Today's subject is the recently expanded New York State insurance law and dependents.DEAR CARRIE: My daughter is 26 and a graduate student. She pays about $300 a month for health insurance through her school. I want to include her on our family group plan, but I was told that every member of the group would have to pay the $50-a-month rider. We have 13 families in our employer-sponsored group, and none have children who would benefit from the rider, so no one wants to pay. The only way to add her to my insurance is to buy an individual policy, but that would cost more than she is paying now. Am I being given correct information?- Insurance Quandary
DEAR INSURANCE: Yes, the information is correct.
The health insurance legislation that Gov. David A. Paterson signed into law July 29 allows parents to carry dependents on employer-sponsored health plans through age 29. But certain criteria have to be met.
The new law includes two components: a "make available option" and a "young adult option," said Leigha Basini, a state Insurance Department associate insurance attorney. With the make-available option, the policyholder, who is usually the employer, can extend the qualifying age of a dependent covered under the policy by purchasing a rider. The insurer will then add the rider to the premiums of all people with family coverage, not just those families seeking additional coverage. That sounds like the situation you described.
"Because this comes at an additional cost to the employer and/or all people with family coverage, some businesses may opt not to purchase the rider," Basini said.
If that happens, the young adult can purchase coverage identical to the parent's coverage through the young-adult option. With that option, though, the young adult or parent must pay the total premium cost.
If this coverage is too expensive, Basini said, young adults should check to see whether they are eligible for two public programs: Family Health Plus, which provides free coverage, or Healthy NY, which provides coverage at a reduced cost.
For more on Family Health Plus, call 877-934-7587; for more on Healthy NY, go to healthyny.com
DEAR CARRIE: My 28-year-old sister and 25-year-old brother still live with my parents. My father works in the public sector and has benefits through his employer. Both siblings have jobs but no health insurance. Would they be eligible for coverage under my dad's plan?
- Broader Coverage?DEAR BROADER: Several factors would determine whether your siblings are eligible for coverage, Basini said. Your father's policy must be issued in New York; his employer cannot be self-insured, and the employer's policy must include coverage for dependents.
Employees should check with their companies, insurers or benefit administrators to confirm those conditions, she said. Be aware many large employers are self-insured, meaning they pay claims with their own funds. The Insurance Department has no jurisdiction over them.
And many insurers issue their plans from other states. So the law may not apply to individuals who work in New York for businesses based out of state. Federal employees generally have coverage through the Federal Employees Health Benefits Program, so your father may want to determine whether his coverage meets this criteria.
Your brother and sister must fulfill certain requirements also. They must be unmarried, be younger than 30, not be insured by or be eligible for comprehensive insurance through an employer, live or work in New York State or the insurer's service area as defined in the policy, and be ineligible for Medicare.