It's open enrollment time and employees will be getting ready to pick their health insurance coverage for the following year. People who buy their own individual health insurance will be researching their options. And Medicare beneficiaries will be able to change their coverage later this year. As you sign up for coverage this fall, here's what to look for.
Extension of Young Adult Coverage
All health plans must permit adult children to remain on their parents' plans until age 26. It makes no difference if the young adults are married or financially independent. As long as children don't have an offer of coverage from their own employer, parents can keep them on their plan. If you want to put an adult child on your family health insurance plan, you'll be given an opportunity to do so during a special enrollment period. At most companies that will coincide with open enrollment. Even if it doesn't, insurers and employers are required to notify you of the special enrollment period. Look for that notice.
Effect of Young Adult Coverage on Health Insurance Cost
Under the law, plans can't charge more for adult children than for dependents younger than 19. But they can increase the cost of family coverage overall, and many will do so, according to an employer survey released last week by the benefits consulting firm Mercer. The survey found that more than half of employers that plan to shift more costs onto employees' shoulders will do so by disproportionately increasing the cost of family coverage compared with employee-only coverage. As part of their efforts to rein in costs, employers are also more likely than before to ask employees to verify that dependents are eligible for coverage, say experts. More than 40 percent of ineligible dependents are children younger than 19. Often the eligibility change is part of the fallout from divorce. Children may no longer live with or be financially dependent on the parent whose insurance covered them, for example, potentially making them ineligible under plan rules. Most of the time, employees are covering ineligible dependents because they don't know the rules of their plan. This can also be true for adult children on their parents' plans.
Prohibition on Coverage Exclusions for Children with Preexisting Conditions
Employer plans can no longer refuse to cover children younger than 19 because they were born with or develop a serious medical condition. The ban on coverage exclusions also applies to new individual policies purchased for a child. A similar ban on coverage exclusions for adults goes into effect in 2014.
Restriction on Annual Dollar Coverage Limits
In general, employer plans can't impose annual coverage limits of less than $750,000 for "essential" health benefits, including hospital services, drugs, emergency services and maternity and newborn care. The maximum limits increase every year and they are eliminated in 2014. These limits apply to new individual policies, too.
Additional Provisions for New Plans
- Cover the full cost of preventive services that have the highest recommendation of the U.S. Preventive Services Task Force.
- Allow women to see an OB-GYN without a referral.
- Do not make plan members pay higher co-payments or coinsurance for out-of-network emergency services