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Dependent Child Eligibility

For plans that are subject to healthcare reform, coverage of dependent children must be offered, or the plan may face a penalty. This requirement applies to both grandfathered and non-grandfathered plans. Eligibility for dependent children cannot be conditioned on student status, marital status, availability of coverage through the child's employer, tax dependent status or whether they live with their parent. While the dependent coverage mandate requires dependents to be covered until age 26, the employer mandate requires that the plan consider the dependent eligible for coverage until the last day of the month in which they turn 26. Plans that offer dependent coverage beyond age 26 must make sure they are complying with Michelle's Law.


Plans that are not subject to healthcare reform's benefit mandates (such as stand alone dental, vision and retiree plans) have some flexibility around what dependents, if any, they will cover.


It is essential for plans to clearly define a child in their plan documents. This is especially true now that the typical nuclear family structure has changed. For example, plans should consider whether they will cover grandchildren and children of domestic partners. If plan language is unclear, state or federal laws may be considered if a child eligibility issue goes to court.


The content described on this page is current as of 2018 and is not intended to be legal or tax advice and should not be construed as such. The intent is to provide information only. Meritain encourages plans to consult with their own legal counsel and tax experts for legal and tax advice.