Required dependent coverage

[Guest dhp]

"If children are eligible for coverage under the policy, any age limitation for an unmarried child may not be less than 25." This is a TEXAS state mandated provision. We have an ERISA self-funded plan and I am not aware of any mandates of this nature. If someone could point me to the section of the code that outlines dependent/spouse coverage, it would be greatly appreciated.

[oriecat]

I'm confused by your question. Are you saying that you are not in Texas and want to know if any place else has similar mandates?

[RTK]

there is no general code or erisa section outlining spouse or dependent coverage requirements for ERISA self-funded plan from coverage prespective (note there are some mandated type coverage issues, e.g. QMCSO, COBRA and HIPAA portability)

[Guest dhp]

Apologize for confusion. We are in Texas, but we are an ERISA self-funded plan not subject to Texas mandates. Fully insured plans in Texas have to follow the mandate noted--if they cover dependents, must cover to age 25 for unmarried children. Although our plan covers dependents to age 25, they are required to be full time students. I am looking for the code section that states that we can determine our dependent coverage--thus backing up our full time student provision.

[jeanine]

First check Texas law (excuse me for not knowing what to refer to--in Ohio it is the Revised Code). Anyway, there should be a general statement that states to whom/what the Texas law applies. For example, policies issued under section *** of your revised code. It may even state that it does not apply to self-funded plans.

[mbozek]

ERISA section 514(b) preempts state laws, including insurance laws, from applying to a self funded health plan subject to ERISA. Therefore Texas law determining who is a dependent for coverage purposes is preempted as it applies to a self funded plan.

[Don Levit]

Mbozek's answer is correct, as long as you are not part of a multiple employer self-funded plan. If you would like for me to locate the corresponding provision in the Texas Insurance Code, please e-mail me.

Don Levit

[Guest dhp]

Thanks, this is exactly the information I needed.