3901-8-13 Notice of older age child to age twenty-eight coverage extension.

(A) Authority

This rule is promulgated pursuant to section 3901.041 of the Revised Code to implement sections 1751.14 , 3923.24 , and 3923.241 of the Revised Code concerning extending the age of health coverage for an employee's unmarried child to age twenty-eight.

(B) Purpose

The purpose of this rule is to establish requirements for notice to be given to insurance policy and certificate holders, "HIC" subscribers and public employee benefit plan members of the opportunity for enrolling eligible children up to age twenty-eight under the parent's health coverage.

(C) Notice of older age child enrollment opportunity

A subscriber, insured, or plan member must be given notice and information regarding the opportunity to continue coverage for or enroll an eligible child up to age twenty-eight in the parent's health coverage as described in the above statutes in the following circumstances:

(1) During the employer's annual enrollment period.

For plan or policy years beginning on or after July 1, 2010, if the subscriber, insured or employee has an annual period during which it is permitted to change coverage and add dependents, he or she must receive written notice of the opportunity to enroll older age children at this time. If there is no annual enrollment period, all subscribers, insureds or employees must receive written notice of the opportunity to enroll older age children within thirty days prior to the time that the coverage renews. Notice of the older age coverage opportunity must be provided to all subscribers, insureds or employees receiving coverage under policies or plans that provide dependent coverage subject to the statutes listed above. After September 23, 2010, notice may be provided pursuant to this paragraph (C)(1) of this rule or may be provided pursuant to the federal special enrollment opportunity rules described in paragraph (C)(2) of this rule.

(2) A special enrollment opportunity.

For plan or policy years beginning on or after September 23, 2010, plans and issuers must give children who qualify an opportunity to enroll that continues for at least thirty days regardless of whether the plan or coverage offers an open enrollment period. This enrollment opportunity and a written notice must be provided not later than the first day of the first plan or policy year beginning on or after September 23, 2010. Coverage under special enrollment is effective the first day of the first plan year on or after September 23, 2010.

(3) When the child reaches the limiting age.

For a child currently covered by a parent's contract, policy, or plan, the notice informing the subscriber, insured, or plan member that the child is about to reach the terminating age under the health coverage must inform the subscriber, insured, or plan member about the option to request the extension of coverage. The notice must include the cost, or the steps to follow to obtain the cost information, as well as the steps to take in order to enroll for the extension of coverage. The subscriber, insured, or plan member must be given the option of enrolling the older age child for continuous coverage within the time frames established under the health contract, policy, or plan.

(4) When a child experiences a change in circumstances.

Notice of the opportunity to elect coverage must be provided upon the request of a subscriber, insured or plan member when an older age child experiences a change in circumstances and thereby becomes eligible for extended coverage. A change in circumstances can include moving back to Ohio or the child losing employer-sponsored coverage. Upon receiving the request from the subscriber, insured or plan member, the eligible older age dependent must be offered the opportunity to enroll within thirty days. Coverage must be effective within thirty days of the health insuring corporation, insurer, plan or administrator receiving both the notice of the election and the premium payment

(D) Severability

If any paragraph, subparagraph, term, or provision of this rule be adjudged invalid for any reason, such judgment shall not affect, impair, or invalidate any other paragraph, subparagraph, term, or provision of this rule, but the remaining paragraphs, subparagraphs, terms, and provisions shall be and continue in full force and effect.

R.C. 119.032 review dates: 01/08/2014 and 08/31/2018
Promulgated Under: 119.03
Statutory Authority: 3901.041
Rule Amplifies: 3923.24 , 3923.241 ; 1751.14
Prior Effective Dates: 6/7/2010 (Emer.), 8/26/2010