III.B · Group Medical Expense Insurance
Dependents, domestic partners and blanket insurance
Dependent children: when a group plan offers dependent coverage, it must make it available to children until age 26. For a child under 26, the plan cannot add conditions such as marital status, student status, residency or financial dependency (45 CFR §147.120). The PPACA chapter covers this in more detail.
Registered domestic partners (§10121.7): a group health policy that provides hospital, medical or surgical benefits must cover a registered domestic partner to the same extent, and on the same terms and conditions, as a spouse. It may not discriminate between different-sex and same-sex spouses or partners. The policy may ask for a copy of the Declaration of Domestic Partnership only if it also asks employees with covered spouses to verify the marriage.
Excess dividends (§10270.65, listed in the outline under dependents): if total dividends or premium refunds exceed what the policyholder spent from its own funds on the insurance, including administration, the policyholder must apply the excess for the benefit of insured employees generally or their dependents. Example: $75,000 in dividends minus $60,000 spent leaves $15,000 to apply for the employees.
Blanket insurance (§10270.2): one master policy insures, by description, all or nearly all people in a defined class, not by naming them. Typical classes are passengers of a common carrier and students of a school; sports teams and camps also buy it. The cost may be paid by the policyholder, or by the insureds or their parents through the policyholder. A minimum participation provision is allowed but not required.
A blanket policy issued to a sports team or camp may not be marketed or sold as a substitute for health coverage that complies with the Affordable Care Act.
Remember
· Registered domestic partner = same coverage and terms as a spouse.
· Blanket = insured by class description, not by name.
· Camp or team blanket policy is not a substitute for ACA coverage.
· Dependent children: coverage available to age 26.
CA
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