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These questions and answers are for consumers of financial products seeking answers regarding Health Insurance questions. If you are a business, Industry or regulated entity, please check our industry questions.
What can I do to keep my premiums reasonable?
It should be noted that your insurer may be able to offer more affordable options than your current coverage. In addition, there are other options available to policyholders, though they may be subject to income limitations for eligibility. You can also visit the New York State of Health Marketplace to review your option for coverage.
The Department requires your insurer to make available all options, including less expensive options, to its small group members when they call to discuss their coverage. Should you choose to communicate with your insurer to discuss less expensive options and your insurer fails to fully divulge such options, you may file a complaint with the Department.
Many associations offer health insurance at group rates. Examples of associations include the Chamber of Commerce, NYS Nurses Association, and the American Bar Association.
I just received notification that my rates are increasing. How do I know they are charging me the correct amount?
You may contact the DFS. We will check the rates being charged and inform you of our review.
* The minimum MLR for Medicare Supplement (Medigap) insurance differs. Commercial for-profit insurers must meet a minimum MLR of 75% for Group insurance and 65% for Individual insurance. Not-for-profit insurers must meet a minimum MLR of 80% for Group and Individual insurance.
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
The coverage must:
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
The parent must be covered under the group policy as an employee or member of the group 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:
Please note that the young adult does not have to live with a parent, be financially dependent on a parent, or be a student.
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, young adults and their parents will be able to access the young adult option once 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. The young adult option must be included with all new policies issued on or after September 1, 2009.
Who will notify me of this benefit?
The insurer will provide written notification to group members or employees (not young adults) in each certificate of coverage and at least 60 days prior to the date the young adult who is covered as a dependent under the parent's policy would otherwise have coverage terminate due to reaching the maximum age for dependent coverage.
Insurers must also notify employees or group members of the initial 12-month open enrollment period, which runs for 12 months following the date that coverage through the young adult option becomes available under the policy or contract.
If you think that you are eligible for this benefit but your parent did not receive notice, please contact your parent's insurer.
When may I enroll?
There are four times when you may enroll:
If I elect this benefit, when will my coverage start? Will it be retroactive to the last time that I had coverage?
Coverage will be retroactive if you elect it within 60 days of the date that you would otherwise age off a parent’s policy. In all other cases, coverage will be prospective and will start no more than 30 days from the date that the insurer receives notice of your election and premium payment.
What is the cost?
The young adult or his or her parent will be responsible for a separate premium for the young adult option (over and above what the parent pays for the group coverage).
How do I enroll?
To enroll, you should notify your parent's employer or benefits administrator in writing and include payment of the first month's premium. Contact the plan administrator or insurer to find out the amount of the premium.
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.