New Age 26 Adult Dependent Rule for Adding Dependent Coverage: Equity-League Fund

Under President Obama’s Health Care Reform Law, the Patient Protection and Affordable Care Act requires all plans that offer dependent coverage for children must make such coverage available to a participant’s adult child whether, married or unmarried, until the child reaches age 26, even if the adult child no longer lives with the parents, is not a dependent on a parent’s tax return or is no longer a student. However, the extended eligibility does not apply to the adult child’s spouse or children.

The new law would ordinarily take effect on June 1, 2011, but the Trustees elected to make this coverage available earlier. This change in dependent coverage eligibility became effective for coverage beginning on or after October 1, 2010. Please note that under this transition rule, if the adult child has another offer of employment-based health coverage other than the Equity-League coverage, dependent coverage for that child will not be available. This condition is subject to change in 2014 based on pending legislative review under the Health Care Reform Act.

You will also have the opportunity to enroll your dependents during the Health Fund’s regularly scheduled Open Enrollment Period in November of each year for coverage beginning on January 1 of the following year. Please note that you will still have to self-pay for this coverage. This new option pertains to both the Point of Service (POS) CIGNA Plan and any HMO Plan you are currently enrolled in. Enrollment forms and self-pay dependent rates can be downloaded under the Self-Pay Dependent Coverage link when selecting the Health Tab from the site’s homepage. As a reminder, you MUST also provide proof of dependent status by attaching a copy of the adult child’s birth certificate to the enrollment form.

Once the dependent reaches age 26, the coverage will end as of the month he/she turns age 26. For example, if a dependent turns 26 on March 1st of a given year, his/her coverage will only remain active through March 31 of that year.

Dependents who no longer qualify as a dependent though will be given the opportunity to elect COBRA up to 36 months. Please be aware that this only pertains if the dependent is covered by employment or already enrolled under COBRA. If a dependent is covered under Vested Beyond COBRA or Supplemental Medicare coverage, by Federal Law, there are no COBRA rights. The coverage will just terminate after the end of the month for which the dependent no longer qualifies as a dependent.

Payments for the adult dependent coverage made by check are to be made payable to the Equity-League Health Trust Fund. To pay by credit card, click on the Health Care Payments link from our website’s homepage for additional payment details.

Please mail the completed form and proof of the adult dependent status in the enclosed gold envelope to:

Equity-League Health Trust Fund

P.O. Box 11533

New York, NY 10286-1533

If payment is made by credit card, please include a copy of your receipt, along with the form(s) and proof of the adult dependent status. You may also fax this information directly to the Health Department at (212) 869-3323.

For any questions, please contact the Fund Office and a customer service representative within the Health Department can assist you.