R590. Insurance, Administration.R590-259. Dependent Coverage to Age 26.
R590-259-1. Authority.
This rule is promulgated by the commissioner pursuant to Sections 31A-2-201, 31A-2-212, and 31A-22-605.
R590-259-2. Purpose and Scope.
(1) The purpose of this rule is to clarify standards relating to dependent coverage of a child in a health benefit plan.
(2) This rule applies to an insurer providing a health benefit plan.
R590-259-3. Definitions.
Terms used in this rule are defined in Sections 31A-1-301, 31A-22-611, and 31A-30-103. Additional terms are defined as follows:
(1) "Child" means an individual who is a son, daughter, stepson, or stepdaughter of an insured.
(2) "Grandfathered plan" is as defined in 45 CFR 147.140.
R590-259-4. Eligibility for Dependent Coverage to Age 26; Uniformity of Plan Terms.
(1) A health insurer that provides dependent coverage shall make that coverage available until the end of the month the child turns 26 years of age.
(2) With respect to a child who has not turned 26 years of age, an insurer may not define a dependent for purposes of eligibility other than in the terms of a relationship between a child and the insured.
(3) An insurer may not deny or restrict coverage for a child who has not turned 26 years of age based on:
(a) the child's financial dependency;
(b) the child's residency;
(c) the child's student status;
(d) the child's employment status;
(e) the child's eligibility for other coverage, except as provided in Subsection (5); or
(f) any combination thereof.
(4) The dependent coverage may not vary based on age except for a dependent with a disability.
(5) A group grandfathered plan issued before January 1, 2014, may exclude an adult child who has not turned 26 years of age if the adult child is eligible to enroll in an eligible employer-sponsored health benefit plan, as defined in section 5000A(f)(2) of the Internal Revenue Code, other than an eligible employer-sponsored health benefit plan of a parent.
R590-259-5. Severability.
If any provision of this rule, Rule R590-259, or its application to any person or situation is held invalid, such invalidity does not affect any other provision or application of this rule that can be given effect without the invalid provision or application. The remainder of this rule shall be given effect without the invalid provision or application.
KEY: health insurance open enrollment
Date of Last Change: November 21, 2023
Notice of Continuation: January 7, 2026
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-605
