Notice Requirement:The regulations required a plan to give such a child an opportunity to enroll that continued for at least 30 days (including written notice of the opportunity to enroll), regardless of whether the plan or coverage offered an open enrollment period and regardless of when any open enrollment period might otherwise occur. This enrollment opportunity (including the written notice) must have been provided not later than the first day of the first plan year beginning on or after September 23, 2010.×
Note: Effective for plan years beginning on or after September 23, 2010. Applies to both grandfathered and non-grandfathered plans.
Plans that offer coverage for dependent children are required to make coverage available until the child reaches the age of 26, regardless of dependency status, residency status, marital status, student status or employment. This does not mandate that a plan cover dependent children, it only states that IF the plan covers children, certain requirements must be met.
There was one exception that was in force until 2014. The exception stated that grandfathered plans were not required to offer coverage to a dependent child under the age of 26 if that child had another offer of employer-based coverage (aside from coverage through his or her parent). This exception no longer applies so ALL plans need to make sure they are complying with all provisions.
A child for the purpose of this provision is defined as:
Children placed for adoption; and
Plans are not required to cover the children of children or a spouse of a child. For any child not listed above, such as a grandchild, niece or nephew, a plan may still impose additional eligibility limitations, such as a condition that the individual be a dependent for income tax purposes.
The ACA also amended the Internal Revenue Code to extend the individual federal income tax exclusion for medical care benefits under an Employer-provided plan. Benefits provided to an employee's child who has not turned age 27 as of the end of the year are excludible even if the child does not otherwise meet the Code's definition of dependent.