From: Julie Ward

To: EBSA, E-OHPSCA - EBSA

Subject: Comments on RIN 1210-AB41

Date: Friday, August 06, 2010 1:20:42 PM

Attachments: Dependent coverage on letterhead FINAL.doc

Please find attached comments on the dependence coverage interim final rule (RIN 1210-AB41) from

the Consortium for Citizens with Disabilities Health Task Force. We appreciate the opportunity to

comment.

Julie Ward

Director of Health and Transportation Policy

Disability Policy Collaboration--A Partnership of

The Arc and United Cerebral Palsy

1660 L Street NW Suite 701

Washington DC 20036

(202) 783-2229 phone

(202) 783-8250 fax

jward@ucp.org
1660 L Street, NW, Suite 701 • Washington, DC 20036 • PH 202/783-2229 • FAX 783-8250 • Info@c-c-d.org • www.c-c-d.org 

August 6, 2010 

Mr. Jim Mayhew 

Office of Consumer Information and Oversight 

Department of Health and Human Services 

Attention: OCIIO-9994-IFC 

P.O. Box 8016 

Baltimore Maryland 21244-1850 

RE: Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to 

Dependent Coverage of Children to Age 26 under the Patient Protection and Affordable 

Care Act (RIN 0991-AB66) 

Dear Mr. Mayhew: 

The following members of the Consortium for Citizens with Disabilities (CCD) Health 

Task Force are writing to express their support for the Interim Final Rules for Group 

Health Plans and Health Insurance Issuers Relating to Dependent Coverage of Children 

to Age 26 under the Patient Protection and Affordable Care Act (PPACA) and to offer 

additional recommendations. 

The CCD Health Task is a coalition of national consumer, service provider, and 

professional organizations which advocate on behalf of persons with disabilities and 

chronic conditions and their families. The CCD Health Task Force is working to ensure 

that health care reform provides all Americans, including people with disabilities and 

chronic conditions, access to high quality, comprehensive, affordable health care that 

meets their individual needs and enables them to be healthy, functional, live as 

independently as possible, and participate in the community. 

The extension of dependent coverage of children to age 26 will have a positive effect on 

young adults with disabilities. Prior to the enactment of PPACA, when young adults 

were dropped from coverage at age 19, many tried to enroll in Medicaid. Now, these 

young adults can remain covered until age 26 and will hopefully transition to employer 

sponsored health insurance. This not only helps many individuals with disabilities, but 

reduces the burden on the Medicaid program. 

Since this provision is critical to young adults with disabilities, we want to ensure that the 

interim final rules do not hurt their protections. Therefore, we have three 
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recommendations to guarantee that young adults with disabilities will be able to keep 

necessary coverage. 

1) Add an additional reference to other plans outside the definition of “eligible 

employer-sponsored group health plan.” 

Currently, an “eligible employer-sponsored group health plan” is defined in IRC 

5000A (f) (2) as “a group health plan or group health insurance coverage offered by 

an employer to the employee which is (A) a governmental plan, or (B) another plan or 

coverage offered in the small or large group market within a State.” However, the 

statute fails to describe the characteristics of such a plan. It would be helpful to also 

reference regulations in 45 CFR 146.145 that explain that plans which only offer 

excepted benefits or that cover only accidents or disability are not eligible employersponsored health plans. 

2) Do not consider temporary coverage policies as “eligible employer-sponsored 

group health plans.” 

It is critical for young adults, especially those with disabilities, to get a variety of 

work experiences. During that time of exploration, young adults who have temporary 

jobs or work as short-term interns are sometimes offered temporary health coverage. 

These plans are not guaranteed renewable and do not provide portability protections. 

If an individual is offered an employer-sponsored group health plan, he or she is no 

longer able to remain on his or her parent’s plan. These plans should not be 

considered eligible employer-sponsored plans so that young adults can be much better 

protected under their parent’s plan. 

3) Ensure that young adults can stay on their parents plan until they receive full 

coverage from an employer. 

Even after a young adult has a qualifying offer of employer-sponsored insurance, the 

dependent may not have access to care immediately. Regulations should make clear 

that young adults may stay on their parents’ grandfathered plan until fully covered by 

their own employer plan. Simple confusion over the rule could prevent a dependent 

from maintaining coverage. For example, an insurer could ask a plan holder whether 

her dependent works for a company that provides health insurance to employees. A 

“yes” answer from the beneficiary would end coverage for her dependent, even if the 

child had to wait before joining an employer’s plan. To avoid the problems 

surrounding waiting periods the regulations should state clearly that grandfathered 

plans can exclude adult dependents only when the dependent can receive full 

coverage under an employer-sponsored plan. The text should include an example 

where an adult dependent covered by a grandfathered plan finds a job but must wait 

to obtain employer sponsored insurance. The conclusion should affirm that 

grandfathered plans cannot drop dependents while they wait for coverage from an 

employer. 

Finally, the agencies should remind states that state and federal protections regarding preexisting condition exclusions for young adults are unchanged by PACCA until 2014 and 
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that stronger state protections will not be pre-empted. CCD recommends that you send a 

letter to state insurance commissioners reminding them of the protections that young 

adults have against pre-existing condition exclusions in group plans under federal law 

and that states have authority to set more protective standards in the group market and to 

set standards. 

 

CCD appreciates the strides that have been taken to support and protect individuals with 

disabilities under the Affordable Care Act. Please take these recommendations into 

consideration to maintain the intent of the Affordable Care Act. If you have any 

questions, please feel free to contact any of the Health Task Force Co-Chairs listed 

below. Thank you for your consideration of our comments. 

Sincerely: 

CCD Health Task Force Co-Chairs: 

Mary Andrus Tim Nanof Angela Ostrom 

Easter Seals AOTA Epilepsy Foundation 

(202) 347-3066 (301) 652-2682 (301) 918-3766 

Peter Thomas Julie Ward 

Brain Injury Association of America The Arc and UCP 

(202) 466-6550 (202) 783-2229 

CCD Health Task Force Members 

Alexander Graham Bell Association for the Deaf and Hard of Hearing 

American Association of People with Disabilities 

American Diabetes Association 

American Occupational Therapy Association 

Association of University Centers on Disabilities 

Brain Injury Association of America 

Children and Adults with Attention-Deficit/Hyperactivity Disorder 

Community Access National Network 

Easter Seals 

Epilepsy Foundation 

Family Voices 

National Alliance on Mental Illness 

National Association of Councils on Developmental Disabilities 

National Association of State Head Injury Administrators 

National Association of County Behavioral Health and Developmental Disability 

 Programs 

National Disability Rights Network 

National Spinal Cord Injury Association 

NISH 
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Paralyzed Veterans of America 

The Arc of the United States 

Tourette Syndrome Association 

United Cerebral Palsy 

United Spinal Association