Coverage Expansion Through Age 29
"Make Available" Option - Frequently Asked Questions
When does this law take effect?
The law affects policies or contracts issued, renewed, modified, altered or amended on or after September 1, 2009. For most existing policies, the individual or group policy holder/contract holder will be able to elect the make available benefit when the right attaches to the policy. For most policies, this will happen on the policy's first renewal date on or after September 1, 2009. You can contact your insurer or group administrator to determine the renewal date. Insurers must offer the make available option to the policy holder/contract holder with all new policies issued on or after September 1, 2009.
Who is eligible?
In order to participate, the “Age 29” law requires the coverage, the young adult’s parent, and the young adult to meet certain requirements.
The coverage must:
- Be an individual, group or group remittance health insurance policy that includes coverage for dependents;
- Be issued in New York State and subject to New York State laws; and
- Be fully insured (this benefit does not apply to self-funded plans).
Please contact your employer, employee benefits administrator or insurance company to find out what state laws apply to the policy and if your coverage is fully insured.
The parent must be covered under the policy or pursuant to a right under the federal Consolidated Omnibus Budget Reconciliation Act (COBRA) or state continuation coverage law.
The Young Adult
The young adult must:
- Be unmarried;
- Be 29 years of age or under;
- Not be insured by or eligible for comprehensive (i.e., medical and hospital) health insurance through his or her own employer; and
- Live, work or reside in New York State or the health insurance company’s service area.
Please note that the young adult does not have to live with a parent, be financially dependent on a parent, or be a student.
What is the cost?
For People with Group Coverage
Employers or group policy holders/contract holders who choose to extend the age of dependency under the policy through the age of 29 will purchase a rider from their insurer. The rider will apply to all people with dependent coverage under the policy. Any additional premium costs as a result of the rider will apply to all people with dependent coverage under policy and not just the newly covered young adults.
If an employer elects the make-available option and contributes to the cost of dependent coverage, then the employer will also be responsible for contributing to the cost of dependent coverage for these young adults through age 29, at the same rate or percentage as for other dependents.
For People with Individual Coverage
People with individual coverage may purchase a rider to extend the age of dependent coverage through age 29. The individual policy holder/contract holder would be responsible for paying the applicable premium for family coverage.
How will I receive notice of this benefit, and when may I purchase this coverage?
For People with Group Coverage
The insurer will provide written notice to the employer or group policy holder/contract holder prior to the inception of the group policy/contract and annually thereafter prior to the renewal date. Coverage may be purchased at this time.
For People with Individual Coverage
For new policy holders/contract holders, the insurer will provide notice to the individual policy holder/contract holder prior to the inception of the individual contract. For existing policy holders/contract holders, the insurer will provide notice at the first renewal date of the policy/contract following September 1, 2009. Coverage may be purchased at this time.
I am an employer and want to make coverage available to my employees’ dependents through age 29. What should I do?
If you are an employer and want the make-available benefit, then you should contact your insurer for information on this benefit. You will need to purchase a rider to extend the age of dependent coverage.
Do employers have to provide the make-available benefit?
No. Employers are not required to offer the benefit.
Does this law apply to self-funded plans?
No, it does not apply to self-funded/self-insured plans, due to federal preemption under the Employee Retirement Income Security Act (ERISA). You can contact your employer, benefits administrator or insurance company to determine if your plan is self-funded.
Does the make available option apply to municipal cooperatives?
Municipal cooperatives are not required to extend the age of dependency under the policy but may do so if they wish.
Does the make available option apply to Healthy NY?
The make available option is available to coverage through an individual or group Healthy NY policy.
Are there any other insurance plans that this law does not apply to?
The law does not apply to dental only, vision only, pharmacy only, accident only or specified disease coverage.
I have a child. Does this make me ineligible?
No. Young adults with children may be covered through the make available option if they meet the eligibility criteria. However, young adults’ children cannot be covered under the “Age 29” law. If you need to cover you children, you may want to consider Child Health Plus. Child Health Plus is available at a reduced premium to children in families who are up to 400% of the Federal Poverty Level ($58,280 for a family of two) and at full price for children above that level.
I am eligible for employer-sponsored coverage, but it has very poor benefits. Am I eligible?
If your employer provides comprehensive insurance that includes medical and hospital benefits, then you may not obtain coverage through the make available option. If your employer provides coverage that does not include medical and hospital benefits, then you may be eligible if you meet the other requirements.
If I exhaust my benefits under the “Age 29” law, may I elect COBRA or state continuation coverage and receive an additional 36 months of coverage?
If you are covered through the make available option, then you would be eligible to elect COBRA or state continuation coverage, if you meet the criteria for COBRA or state continuation.
What options do I have if my parent’s employer does not make this benefit available to me?
If you currently are covered as a dependent through a parent’s policy but are about to age off due to reaching the maximum age of dependency, you may be able to elect COBRA/state continuation coverage for up to 36 months. You would be responsible for up to 102% of the premium. You may be able to elect coverage under the “Age 29” young adult option, through which you could be covered through age 29, as long as you meet the eligibility requirements. You could consider Healthy NY, which provides reduced-cost coverage to those people meeting eligibility requirements. You may also want to consider Family Health Plus, which provides free coverage to people meeting income and other eligibility requirements.
I am covered through an individual policy that I purchased on my own. May I still get coverage through the make available option?
If you have coverage as an individual, then you may make obtain coverage through the make available option if you meet the eligibility requirements. If you have coverage through your employer, then you cannot obtain coverage through the make available option, because you have employer-sponsored insurance.
I am a parent and currently have Healthy NY. Is my child eligible for this coverage?
Individuals, sole proprietors, and small employers with Healthy NY may purchase a rider to make coverage available for young adults through the age of 29.
If my parent’s employer offers several different benefit packages, do I get to choose which one I want?
Insurers and employers are not required to offer different benefit packages for the young adult option.
When will coverage end?
Coverage will end when one of the following occurs:
- You terminate your coverage pursuant to the terms of the policy.
- Your parent’s coverage terminates.
- You no longer meet the eligibility requirements.
- The insurance policy is terminated and not replaced.
If I exhaust my benefits under the make available option, may I elect COBRA and/or state continuation coverage and receive an additional 36 months of coverage?
If you are covered through the make available option, then you would be able to elect COBRA/state continuation coverage for up to 36 months, assuming you meet the criteria for COBRA/state continuation coverage. For more information on COBRA and state continuation coverage, select this link.
What if I need more information about this law?
Contact the Department of Financial Services's Consumer Assistance Unit at (212) 480-6400 or 1-800-342-3736.