OHI and Adult Children

[Shadowbunny]

What is the name of your state? UT/WY

For my health-benefits gurus out there, I have a question.

I'm familiar with how TRICARE works, which is that coverage for adult children under the age of 26 isn't automatic (they must enroll and pay separate premium), and coverage ends when the child gets married or otherwise has access to health insurance.

For civilian health insurance plans, is it normal to not take an adult child off until Open Season or until reaching the age of 26? Or is it more typical for insurance to be dropped when there's a qualifying event?

For context, I have a Soldier whose wife is covered by her Dad's insurance. Dad is saying he can't take daughter off until she's 26, even though she's covered by Tricare. Could this be true?

@cbg @commentator @PayrollHRGuy

 

[cbg]

For civilian plans, she would AUTOMATICALLY come off when she turns 26, although it can vary with the employer whether it's on her 26th birthday, the last day of the month in which her 26th birthday falls (what we do), or on the December 31 of the year in which she turns 26 (uncommon, but not unheard of). But on most civilian plans she can also come off within 30 days of the date in which she acquires other coverage, or during the annual Open Enrollment. I suppose it's possible that Dad's plan is light on Qualified Life Events, but I think it's more likely that Dad is confused and believes that he MUST cover her until 26, not that he MAY cover her until 26. I had to explain that to a few people here when the law was first passed.

 

[Shadowbunny]

Thanks, cbg, that makes sense.

Honestly, I was just so surprised that civilian plans allowed anyone to stay on a minute past the time they had other coverage that I didn't think it was possible at all. But staying on until Open Season? That's just madness in my world!!!!

 

[cbg]

In the private sector, the times at which you can make changes to your coverage are limited. There are certain qualified life events - marriage, birth, divorce, adoption, loss or gain of other coverage, loss or gain of eligibility - when you can make changes that relate to the QLE, and then there is your annual Open Enrollment. This is particularly important with benefits that are deducted on a pre-tax basis. Our plan year runs alongside the calendar year (as opposed to our fiscal and school year, which runs July 1 to June 30) so we're just in the OE clean-up stages now. What really gets complicated is when we have New Hires or Qualified Life Events in the 4th quarter of the year, when they're looking at both the outgoing and the new year. Oh, the life of a Benefits representative can be a very complicated one!

 

[PayrollHRGuy]

Insurance companies love having 26-year-olds on their plans. In most cases, they are pure profit.

 

[LdiJ]

Insurance companies love having 26-year-olds on their plans. In most cases, they are pure profit.

Unless they are having babies.