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Adult Dependent Coverage & an "eligible employer-sponsored health plan"?


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Guest Benefitsrock
Posted

A grandfathered plan can deny an adult dependent coverage if he is eligible to enroll in an "eligible employer-sponsored health plan."

Does an "eligible employer-sponsored health plan" include a plan of which the employer is not the adult dependent's employer? For instance, if an adult dependent's spouse has health coverage due to her employment and the adult depedent is eligible to participate in his spouse's plan, can the parent's health plan deny the adult dependent coverage under the parent's plan because he is eligible to participate in his spouse's plan?

Posted

Sounds like it.

http://www.dol.gov/ebsa/pdf/dependentcoverage.pdf

(g) Special rule for grandfathered group health plans—(1) For plan years beginning

before January 1, 2014, a group health plan that qualifies as a grandfathered health plan under

section 1251 of the Patient Protection and Affordable Care Act and that makes available

dependent coverage of children may exclude an adult child who has not attained age 26 from

coverage only if the adult child is eligible to enroll in an eligible employer-sponsored health plan

(as defined in section 5000A(f)(2)) other than a group health plan of a parent.

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