Eligibility of Disabled Child

[Guest irash]

Questioning whether HIPAA prevents an employer from denying a new employee the option to enroll an overage dependent who is totally disabled? Would this constitute a violation of the portability aspect of HIPAA? Thanks!

[GBurns]

What are the grounds for denial?

Is the denial from the employer, the plan or the insurer?

Is the coverage guaranteed issue like almost all group plans?

Did the employee have preious creditable coverage etc?

[Mary C]

Another aspect to consider is whether the overage dependent became disabled prior to or after the limiting age of the contact.

For example, our plan will coverage a disabled overage dependent of a newly hired employee if that dependent became disabled prior to his or her 19th birthday. If the dependent became disabled after their 19th birthday, our plan will not cover them.

[Guest irash]

thank you for the responses thus far. the ground for denial are purely based on the employer's eligibility rules as the overage dependent was not covered under this plan prior to her 19th birthday. for the record, a new hire may add their overage dependent to the plan if they are a full time student.

in this particular case, the child has been deemed totally disabled prior to her 19th birthday and has maintained prior credible coverage up until this point. the plan is guarantee issue.

it seems to me that this is addressed under HIPAA's non-discrimination of similarly situated individuals. for example, a new hire with a 19 year old dependent who is a full time student will be considered eligible for benefits; however, a new hire with a 19 year old disabled dependent would be considered ineligible.

if anyone can point me to a specific portion of HIPAA or cite some other ruling that would allow coverage for this disabled dependent i would appreciate it. thanks.

[Sandra Pearce]

If the overage dependent child meets the Plan's definition of an eligible dependent and was not enrolled when initially eligible due to other coverage which has now been lost (due to loss of eligibility for the coverage) HIPAA's special enrollment provision would apply. Open enrollment provisions would also allow a late entrance into the Plan; however, HIPAA does not require open enrollment.