CESSING OF DENISE

ULATIONS
PRBUESTION SRE ILA REQ-IHY494-10 JUN 4 2010

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As of: June 04, 2010

PUBLIC Status: Posted

Posted: June 04, 2010

SUBMISSION Comments Due: August 11, 2010

Submission Type: Web

Docket: IRS-2010-0011

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

Age 26 under the Patient Protection and Affordable Care Act

Comment On: IRS-2010-0011-0001

Group Health Plans and Health Insurance Issuers Providing DependentCoverage of Children to

Age 26, etc.

Document: IRS-2010-0011-0005
Comment on FR Doc # 2010-11393

Submitter Information

Name: Jennifer C. Jaff
Address:
18 Timberline Drive
Farmington, CT, 06032
Email: patient_advocate@sbcglobal.net
Phone: 860-674-1370
Fax: 860-674-1378
Organization: Advocacy for Patients with Chronic Iliness, Inc.

General Comment

See attached file(s)

Attachments

IRS-2010-0011-0005.1: Comment on FR Doc # 2010-11393

https://fdms.erulemaking.net/fdms-web-agency/component/submitterInfoCoverPage?Call=P...

6/4/2010


Advocacy for Patients
with Chronic Illness, Inc,

18 Timberline Drive
Farmington, CT 06032
(860) 674-1370 (phone)
(860) 674-1378 (fax)
(860) 305-9835 (cell)
www.advocacyforpatients.org
patient_advocate@sbcglobal.net

June 3, 2010

VIA RULEMAKING PORTAL

CC:PA:LPD:PR (REG-114494-10)
Internal Revenue Service

PO Box 7604

Ben Franklin Station
Washington, DC 20044

Re: | Amendments to 26 CFR Part 54 Regarding Insurance Coverage of Children to
Age 26

Dear Sir/Madam:

Thank you for this opportunity to comment on draft regulations governing
health insurance coverage of dependent children until age 26.

Advocacy for Patients with Chronic Illness, Inc. is a 501(c)(3) organization
that provides free information, advice, and advocacy services to patients with chronic
illnesses nationwide. Of particular relevance here, we assist people with chronic
illnesses to find health insurance that covers their pre-existing conditions, and we file
many insurance appeals for coverage of items that insurers believe either are not
medically necessary, or are experimental or investigational. These comments are
based on our experience of working with thousands of people with chronic illnesses
who, by definition, have pre-existing conditions that make it very difficult to obtain
insurance coverage.

We very much support the addition of Section 2714 of the Public Health
Service Act by the Patient Protection and Affordable Care Act (PPACA). We believe
that the regulations are consistent with Congressional intent to cover the broadest
possible group of people who otherwise would have to find health insurance on their
own at a time when they are students or are unemployed, just entering the
workforce. Thus, we support the broad definition of “dependent” to include children
who are not living with their parents, who are not financially dependent, who are
students, or who are employed but not eligible for health insurance through an
employer, It is our understanding, though, that Congress also intended to include,
as a dependent, children who are married (although not their spouses). We would
urge you to add language and/or an example to that effect.


Internal Revenue Service
June 3, 2010
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Our primary concern, though, relates to the transitional rules found in
subsection (f). The draft regulations provide that notice may be given to the
employee. We would suggest that, especially if the employer's plan formerly
covered the dependent and, thus, has an address for him or her, notice should go to
the dependent, as well. Not all employees will convey this opportunity to
dependents in the context of divorces and other family-altering events. If notice to
the dependent is feasible, it should be required.

Second, and most importantly, the draft regulations state that the portability
rules of HIPAA apply, and you have given several examples. What the draft
regulations do not expressly address, though, is coverage of pre-existing conditions.
In section (f)(5) example 1, the dependent has had a break in coverage of more
than 63 days. Although the draft regulations make it clear that this dependent is
eligible for enrollment, the draft does not state that the dependent’s pre-existing
condition is covered despite the break in coverage. This is not a hypothetical
question; we already have fielded this question, and have been unable to find an
unambiguous response. Thus, we strongly urge you to address this issue explicitly.
It is our belief that Congress's intent was to construe these provisions broadly, and
that the dependent’s pre-existing condition should be covered when they re-enroll in
their parent’s plan. However, without clear language on this issue, you can expect
disputes to arise.

Again, thank you for this opportunity to comment on these important
regulations. We very much appreciate your consideration of issues that will affect
the lives of the people with chronic illness whom we represent.

Sincerely,

Jennifer C. Jaff, Esq.
Executive Director