AFSCME .

We Make America Happen

Gerald W. McEntee

President

Lee A. Saunders

Secretary-Treasure r

Vice Presidents

Ken Allen

Portland, OR

Henry L. Bayer

Chicago, IL

George Boncoraglio

New York, N Y

Anthony Cas o

Boston, MA

Greg Devereux

Olympia,WA

Danny Donohu e

Albany, N Y

David R. Fillma n

Harrisburg, PA

Michael Fo x

Harrisburg, PA

Albert Garrett

Detroit, M I

Raglan George Jr.

New York, N Y

Sherry) Gordon

Trenton, NJ

Lakesha Harrison

Oakland, CA

Danny J . Homan

Des Moines, IA

Salvatore Lucian o

New Britain, CT

John A. Lyal l

Worthington, OH

Roberta Lync h

Chicago, IL

Glenard S . Middleton Sr.

Baltimore, MD

Gary Mitchel l

Madison,Wl

Veronica Montgomery-Costa

New York, NY

Doug Moor e

San Diego, CA

Henry Nicholas

Philadelphia, PA

Eddie L . Parks

Westerville, OH

Randy Perreira

Honolulu, HI

George E. Popyack

Oakland, CA

Greg Powell

Austin,TX

Laura Reye s

San Diego, CA

Eddie Rodriguez

New York, N Y

Lawrence A. Roehri g

Lansing, M I

Joseph P. Rugola

Columbus, O H

Kathy J. Sackma n

Pomona, CA

Eliot Seide

South St. Paul, MN

Mary E . Sullivan

Albany, N Y

Braulio Torres

San Juan, PR

David Warric k

Indianapolis, I N

Jeanette D. Wyn n

Tallahassee, FL

®zt 435-1 0

7/10

August 4, 201 0

Office of Consumer Information and Insurance Oversigh t

Department of Health and Human Service s

Attention: OCIIO-4150-IFC

P.O. Box 801 6

Baltimore, MD 21244-185 0

Submitted electronically via www.regulations.gov

Dear Sir or Madam:

I am writing on behalf of the American Federation of State, County & Municipa l

Employees (AFSCME), a union of 1 .6 million active members and retirees throughout

the United States. AFSCME appreciates this opportunity to comment on the Interim

Final Rule implementing the provision relating to dependent coverage of children to ag e

26 under the Patient Protection and Affordable Care Act (PPACA).

AFSCME has fought to improve our health care system for decades and throug h

the tremendous energy and commitment of our members, activists and leaders all over

the country we played an important role in the passage of the PPACA . We believe that

these regulations help to address one of our main health care reform objectives - the

expansion of coverage - and strongly support the addition of Section 2714 of the Publi c

Health Service Act by the PPACA .

We commend the agencies for issuing rules that condition dependent eligibility

only on the relationship between the child and the plan participant, broadly defining

"dependent" to include children regardless of financial dependency, residency, studen t

status, marital status or employment . However, we believe the regulation's basi c

purpose of extending this dependent coverage to as many children as possible would b e

advanced by clarifying that adopted and stepchildren meet the "relationship test ." Doing

so would help this provision align more properly with the provision extending th e

favorable tax treatment of such coverage where the definition of "child" includes both

stepchildren and adopted children . Further, under ERISA, 29 U.S .C . § 1169(c)(1),

group health plans offering dependent coverage must provide benefits to adopte d

children "under the same terms and conditions as apply in the case of dependen t

children who are natural children of participants or beneficiaries under the plan ."

While, to our knowledge, many public sector plans do extend dependent benefi t

coverage to adopted children, it may not always be the case . The addition of this

clarification would ensure equal treatment of public and private sector plans an d

inclusion of step children would be consistent with the intent of the PPACA.

American Federation of State, County and Municipal Employees, AFL-CI O

TEL (202) 429-1000 FAX (202) 429-1293 TDD (202) 659-0446 WEB w ww.afscme .org 1625 L Street, NW, Washington, DC 20036-5687
Office of Consumer Information and Insurance Oversight

August 4, 201 0

Page 2

In addition, we urge the agencies to provide further clarity concerning what constitutes an

"eligible employer-sponsored health plan." Due to the special rule for grandfathered grou p

health plans allowing for the exclusion of adult children (up to age 26) if they are eligible t o

enroll in an eligible employer-sponsored health plan, we are concerned that some adult childre n

may improperly fall under this exemption. Specifically, the regulations should clarify . that

"excepted benefits" and possibly inadequate limited benefit plans are not considered to be

"eligible employer-sponsored health plans" for the purposes of this special rule .

AFSCME appreciates the opportunity to comment on this interim final rule and looks

forward to continuing to work with the Department of Health and Human Services as the variou s

provisions of health care reform are implemented.

Respectfully submitted,

1

Steven Kreisberg

Director of Collective Bar ming and

Health Care Policy

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