Healthcare Reform calls for medical coverage of adult children

Q&A with John Papahronis

published in The Oklahoman | June 18, 2010

McAfee & Taft employee benefits attorney John Papahronis was featured in The Oklahoman discussing the new Patient Protection and Affordable Care Act. It requires that dependent coverage offered to children through group health plans and health insurance issuers must be offered up to age 26.

Papahronis explains that, according to new regulations issued jointly by the Internal Revenue Service, Department of Labor and Department of Health and Human Services, eligibility can only be based on the relationship between the child and the plan participant, and not on factors such as student or marital status. Grandchildren and the spouse of an adult child can be excluded from coverage, but it is still uncertain how stepchildren will be defined.

“Also, for plan years beginning before 2014, if a medical plan was in effect on March 23 (a “grandfathered” plan), the plan may exclude an adult child if the adult is eligible to enroll in an employer-sponsored medical plan other than the group medical plan of the parents,” Papahronis told The Oklahoman.

He goes on to outline notification requirements for the new coverage that becomes effective January 1. Papahronis also cautions employers that if an adult child is eligible for coverage, that child must be treated the same as other dependent children.