The Benefit Trust Fund has received numerous phone calls from our members regarding the new legislation on coverage expansion through age 29. Hopefully, the FAQs below will make it easier to understand the new “Age 29” law.

Q: Who is eligible?
A: In order to participate, the “Age 29” law requires the coverage, the young adult’s parent, and the young adult to meet the following requirements. The coverage must:

• Be a group health insurance policy that includes coverage for dependents;
• Be issued for delivery in New York state; and
• Be fully insured (this benefit does not apply to self-insured plans).

The parent must be eligible for coverage under the group policy as an employee or group member. The young adult must:

• Be unmarried;
• Be 29 years of age or under;
• Not be insured by or eligible for health insurance through his or her own employer;
• Live, work or reside in New York state or the health insurance company’s service area; and
• Not be covered under Medicare.

Please note that the young adult does not have to live with a parent, be financially dependent on a parent or be a student.

Q: When does this law take effect?
A: The law affects policies or contracts issued, renewed, modified, altered or amended on or after Sept. 1, 2009. For most policies, the new benefit will apply on the policy’s annual renewal date.

Q: Who will notify me of this benefit?
A: The insurer will provide written notification to employees in each certificate of coverage and at least 60 days prior to the date the young adult covered as a dependent under the parent’s policy would otherwise have coverage terminated due to reaching the maximum age for dependent coverage.

Q: When may I enroll?
A: There are four times when you may enroll:

• When you would otherwise age off a policy;
• When you experience a change in circumstances;
• During an annual 30-day open enrollment period; and
• During the initial 12-month open enrollment period.

Q: If I elect this benefit, when will my coverage start? Will it be retroactive to the last time that I had coverage?
A: Coverage will be retroactive if you elect it within 60 days of the date that you would otherwise age off a parent’s policy. In all other cases, coverage will be prospective and will start no more than 30 days from the date that the insurer receives notice of your election and premium payment.

Q: What is the cost?
A: The cost may not exceed 100 percent of the single premium rate.

Q: How do I enroll?
A: To enroll, you should notify the insurer in writing and include payment of the first month’s premium. Contact the plan administrator or insurer to find out the amount of the premium.

Q: Does this law apply to self-insured plans?
A: No, it does not apply to self-insured plans.

Q: I’m eligible for coverage through my employer, but it has very poor benefits. Am I eligible for the “Age 29” benefit?
A: If your employer provides health insurance that includes both medical and hospital benefits, then you cannot make an “Age 29” election. If your employer provides coverage that does not include both medical and hospital benefits, then you may be eligible if you meet the other requirements.

Q: What if I need more information about this law?
A: For more information, contact the Insurance Department’s Consumer Services Bureau at (800) 342-3736.

— Doreen Bango, Members Benefits and Services Manager