July 8, 2010 

Amy Turner 

Beth Baum 

Office of Health Plan Standards and Compliance Assistance 

Employee Benefits Security Administration 

Room N-5653 

U.S. Department of Labor 

200 Constitution Avenue, NW 

Washington, DC 20210 

Via Email to: E-OHPSCA.EBSA@dol.gov

Attention: RIN 1210-AB41 

Dear Ms. Turner and Ms. Baum: 

Families USA appreciates the opportunity to submit these comments on 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. Families USA is a national, nonprofit, 

nonpartisan organization for health care consumers. Our mission is to ensure that all Americans have 

access to high-quality, affordable health care. Families USA strongly supports comprehensive, 

affordable health insurance for all residents of this nation. 

We applaud the agencies for issuing rules that are straightforward and clearly state that reaching age 26 

will be the only way a dependent child can be aged out of family coverage. It is appropriate that the 

rules do not require the young adult to reside in the same location nor to be financially dependent in 

order to receive these protections. Further, we applaud the agencies for providing a special enrollment 

period for young adults who may have lost coverage prior to the effective date. However, we do 

recommend that the agencies provide additional guidance on three areas of the transitional rules. 

1) 26 CFR 54.9815-2714T(f); 29 CFR 2590.715-2714(f); and 45 CFR 147.120(f): Transitional 

rules for individuals whose coverage ended by reason of reaching a dependent eligibility 

threshold.

The 30-day enrollment opportunity for a dependent child to enroll begins no later than the first day of 

the first plan year beginning after September 23, 2010. Notice must be provided at the same time and the 

effective date of coverage is also the first day of the first plan year beginning after September 23, 2010. 

The agencies should consider drafting model language for the required notice that could be posted on 

the agencies’ websites. The agencies should also consider posting a FAQ that provides an example of 

notice and retroactive coverage to the first day of the plan year. 

2) 26 CFR 54.9815-2714T(g); 29 CFR 2590.715-2714(g); and 45 CFR 147.120(g): Further clarity 

about definition of “eligible employer-sponsored group health plan.” 

a) Add an additional reference to other plans outside this definition.

1201 New York Avenue, NW  Washington, DC 20005  202-628-3030  Fax 202-347-2417

E-Mail: info@familiesusa.org  Web site: www.familiesusa.org
Under this temporary rule, dependent children who are eligible to enroll in an “eligible employersponsored health plan” need not be given an opportunity to enroll in their parent’s grandfathered group 

health plans. The regulations fail to describe the characteristics of an “eligible employer-sponsored 

health plan.” The statute defines eligible employer sponsored plan 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. Such term shall include a grandfathered plan described in plan....” It would be helpful to also 

reference regulations in 45 CFR 146.145, for example, that explain that plans which only offer excepted 

benefits or that cover only accidents or disability are not eligible employer-sponsored health plans. If it 

is possible under the statute, we would also recommend allowing dependent children to enroll in a 

grandfathered group plan if they only have an offer of a limited benefit policy (mini-med) through their 

own jobs. 

b) Do not consider temporary coverage policies as “eligible employer-sponsored group health 

plans.”

We are also concerned about offerings of temporary coverage policies through a job. These policies are 

sometimes offered to young adults who are short-term interns (temporary employees), for example, but 

they are not guaranteed renewable and do not provide portability protections. They should not be 

considered eligible employer-sponsored plans that would prevent otherwise eligible young adults from 

staying on their parents’ coverage. Young adults would be much better protected by staying on their 

parent’s plan than by accepting a temporary policy. 

3) The agencies should remind states that state and federal protections regarding pre-existing 

condition exclusions for young adults are unchanged by PACCA until 2014, and that stronger 

state protections will not be pre-empted.

We understand that the statute did not make any changes in this area until 2014, but this could be easily 

misunderstood by consumers, regulators, and state legislators. We therefore suggest 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 still have authority to 

set more protective standards in the group market and to set standards in the individual market. For 

example, the letter could remind states that adults over the age of 19 can be subject to pre-existing 

condition exclusions, but if they are rejoining a group plan, pre-existing condition exclusion periods are 

limited to 12 months and would be offset by the months of prior creditable coverage. If states enact 

stronger protections in the group market (lessening exclusionary periods for all consumers, for example, 

or prohibiting pre-existing condition exclusions for young adults rejoining a parent’s plan), these state 

rules would not be pre-empted. Similarly, if states wanted to extend protections to the individual market, 

those state rules would not be pre-empted. 

Thank you for the opportunity to submit these comments. If you have any questions, please do not 

hesitate to contact us at 202-628-3030. 

Sincerely, 

Cheryl Fish-Parcham 

Deputy Director of Health Policy