Prior to the enactment of the Affordable Care Act health benefits plans used language similar to this to explain who is eligible for coverage.
Be sure you have enrolled only eligible dependents for your medical and dental coverage, which includes your spouse, natural children, and stepchildren, foster children dependent on you for support and maintenance, and legal wards. You must have a marriage certificate, birth certificates, or court papers to support each dependent’s status.
Similar language is still used in some plans and it is quite misleading. The words dependent or dependents are no long appropriate in any case when it refers to any child regardless of the child’s age. The problem with using “dependent” in this context is that it may prevent employees from enrolling an eligible child or cause disenrollment of a child who is still eligible. This is most likely to happen as a child graduates from high school around age 17 or 18 when it is questionable whether they are an adult or not.
In fact, no child has to be a dependent and there is no definition of “adult” in the regulations. Here is what the regulation says (note the last sentence I put in bold).
Preamble to May 13, 2010 interim final rule:
Many group health plans that provide dependent coverage limit the coverage to health coverage excludible from employees’ gross income for income tax purposes. Thus, dependent coverage is limited to employees’ spouses and employees’ children that qualify as dependents for income tax purposes. Consequently, these plans often condition dependent coverage, in addition to the age of the child, on student status, residency, and financial support or other factors indicating dependent status. However, with the expansion of dependent coverage required by the Affordable Care Act to children until age 26, conditioning coverage on whether a child is a tax dependent or a student, or resides with or receives financial support from the parent, is no longer appropriate in light of the correlation between age and these factors. Therefore, these interim final regulations do not allow plans or coverage to use these requirements to deny dependent coverage to children.
Because the statute does not distinguish between coverage for minor children and coverage for adult children under age 26, these factors also may not be used to determine eligibility for dependent coverage for minor children.
You can find more on the rules for children here
Related articles
- Increased number of adult children covered by health insurance as a result of the Affordable Care Act (quinnscommentary.com)
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