Dependents through 29
This law gives dependents who “age off” their parent’s policy the right to extend coverage through age 29. It is effective for new groups, renewals, direct pay, and Healthy New York policies effective September 1, 2009 and later.
Young Adult Option
Young adults who qualify for this coverage will have a 12-month open enrollment period—starting upon group effective date or renewal—during which to purchase it. They would simply need to complete an enrollment application and arrange to pay the additional individual premium through the employer group or policy holder.
Make Available Rider Option
Employers, direct pay, and Healthy New York groups/individuals may choose to offer this option—starting upon the policy effective date or renewal—that extends dependent coverage under their parents’ policy through age 29.
Mental Health Parity Act
A new federal mental health parity law has necessitated some contract changes.
LARGE GROUPS
Day and visit limitations have been removed for inpatient and outpatient mental health and substance abuse services. Riders that were available to extend these benefits have been made obsolete.
SMALL GROUPS
The provisions of Timothy’s Law are no longer a part of the base contract, but are available via rider. This is the benefit that gives the member unlimited services for biologically based mental illness and children with serious emotional disturbances. Inpatient 30-day rehabilitation for chemical dependency will also no longer be a base contract benefit, but will be available via a rider.
OTHER MENTAL HEALTH CHANGES
In addition, CDPHP is implementing the following changes.
- If a plan has a deductible, it applies to all mental health/substance abuse services. Mental health/substance abuse services also count toward the coinsurance maximum (if the plan has one).
- Some exclusions have been added or revised to more accurately reflect CDPHP medical policies.
- Psychological and neuropsychological testing language has been updated to reflect additional member liability based on the frequency of services performed.
Note: For the purposes of the federal mental health parity law, the definition of a large group is one that has more than 50 employees. Mental health benefit parity is also being extended to all Group Medicare plans.
Michelle’s Law Protects Student Coverage
This new federal law takes effect for groups renewing coverage on or after Nov. 1, 2009.
Michelle’s Law enables full-time college students who are covered as dependents to retain their health coverage if they take a medically necessary leave of absence. These dependents are entitled to the same level of benefits as if they were not on leave.
In New York, there is already a similar law that extends coverage for students who must drop out of school due to illness. Michelle’s Law provides protection for those who leave college due to an injury as well.
CDPHP may require that a physician certify, in writing, the medical necessity of the leave of absence.
Mini-COBRA Extension
This law is retroactive for any new groups sold and group renewals taking place July 1, 2009 and later. It extends the maximum period of continuation coverage from 18 months to 36 months.
COBRA Subsidy and CDPHP Administration Information
President Obama signed the American Recovery and Reinvestment Act (ARRA) on February 17, 2009. The law gives “assistance eligible individuals” the right to pay reduced continuation coverage premiums.
The best place to get information on the details of the ARRA is directly from the government. Information can be found at:
CDPHP is providing this document for informational purposes only. This document cannot be relied upon as legal or compliance advice with respect to any specific matter. Please consult your attorney for professional advice. You may also wish to contact the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) at www.dol.gov/COBRA or call 1-866-444-EBSA (3272) for additional guidance.