Docket: HHS-OS-2010-0012 

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

Age 26, etc. 

Comment On: HHS-OS-2010-0012-0001 

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

Age 26, etc. 

Document: HHS-OS-2010-0012-DRAFT-0019 

Comment on FR Doc # 2010-11391 

Submitter Information 

Name: Mary Burns 

General Comment 

The comments attached in the file below are submitted on behalf of the NYS Insurance 

Department. 

Attachments 

PUBLIC SUBMISSION 

As of: August 12, 2010 

Received: August 09, 2010 

Status: Pending_Post 

Tracking No. 80b2c155 

Comments Due: August 11, 2010

Submission Type: Web

HHS-OS-2010-0012-DRAFT-0019.1: Comment on FR Doc # 2010-11391

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https://fdms.erulemaking.net/fdms-web-agency/Download?operation=CoverPage&ObjectI... 8/12/2010
Comments to HHS Interim Final Regulations Regarding PPACA §1001 

Dependent Coverage Extension to Age 26 

I. Availability of Coverage. The regulation notes that the family must have “family 

coverage” and the parent(s) and child(ren) will have the same coverage. In some 

instances, a parent may have retiree coverage that is a Medicare Advantage plan. 

Children may not participate in such a plan. Is there any assistance anticipated for these 

people? 

II. Eligibility for Grandfathered Plans. Section 147.120(g)(1) states that for plan years 

beginning before January 1, 2014, grandfathered group plans may decline to enroll adult 

children who are eligible for employer-sponsored coverage. In our experience working 

with issuers on health insurance programs that have eligibility criteria and coverage 

extension laws, issuers will likely request documentation that these adult children are not 

eligible for employer-sponsored coverage. This would be difficult, if not impossible to 

provide. We would suggest amending the regulation to indicate that a self-attestation will 

suffice as proof of ineligibility for employer-sponsored coverage. 

III. COBRA. The regulation does not explicitly state that the extension also applies to young 

adults whose parents have COBRA or elect COBRA. While this is implied, clarification 

may avoid consumer and insurer questions regarding this.

IV. Residency. Some network-based plans require the insured to live, work or reside within 

the service area in order to be eligible for coverage, in part to ensure that people are 

actually able to access the coverage that they have purchased. The law and regulation do 

not note any residency requirements. However, on the May 20, 2010 HHS call with 

states, HHS noted that a residency requirement would apply if such a requirement is 

already in place with the underlying coverage. It should be clear to insureds that access 

to coverage may be limited based on residency.

V. Definition of Children. Neither the statute nor the draft regulation defines “children.” 

We are aware that some insurers are interpreting this silence to mean that only biological 

children must be covered and that insurers and policyholders may cover adopted children 

and stepchildren at their option, unless state law addresses the issue. We would suggest 

that the regulation define “child” to include adopted and stepchildren, as it does not 

appear that the intent of the law was to exclude these children.