“make available” option: frequently asked questions
when does this law come into 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 policyholder/contractor will be able to elect the benefit of making available when the right is attached to the policy. For most policies, this will be on the first policy renewal date after September 1, 2009. You can contact your insurer or group administrator to determine your renewal date. insurers must offer the option to make available to the policyholder/contractor with all new policies issued on or after September 1, 2009.
who is eligible?
In order to participate, the “age 29” law requires that coverage, the young adult’s parent, and the young adult meet certain requirements.
- be an individual, group, or group remittance health insurance policy that includes coverage for dependents;
- be issued in the state of new york and subject to the laws of the state of new york York; and
- be fully insured (this benefit does not apply to self-funded plans).
Contact your employer, employee benefits administrator, or insurance company to find out what state laws apply to the policy and whether your coverage is fully insured.
the parent must be covered under the policy or pursuant to an entitlement under the federal consolidated omnibus budget reconciliation act (cobra) or state continuation coverage law.
the young adult
the young adult should:
- not married;
- age 29 or younger;
- not insured or eligible for comprehensive health insurance (i.e., medical and hospital) through his or her own employer; and
- live, work, or reside in New York State or the health insurance company’s service area.
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/contract holders who choose to extend the age of dependency under the policy to age 29 will purchase a rider from their insurer. the rider will apply to all persons with dependent coverage under the policy. any additional premium costs as a result of the rider will apply to everyone with dependent coverage under the policy and not just newly covered young adults.
If an employer chooses the roll-out 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. rate or percentage as for other dependents.
for people with individual coverage
People with individual coverage can purchase a rider to extend the age of dependent coverage to age 29. the individual policy/contract holder would be responsible for paying the applicable premium for family coverage.
How will I receive notice of this benefit and when can I purchase this coverage?
for people with group coverage
The insurer will provide written notice to the employer or group policy/contract holder prior to the inception of the group policy/contract and annually thereafter prior to the renewal date. coverage can be purchased at this time.
for people with individual coverage
For new policyholders/contractors, the insurer will notify the individual policyholder/contractor prior to the start of the individual contract. For existing policyholders/contractors, the insurer will provide notice on the first policy/contract renewal date after September 1, 2009. Coverage may be purchased at this time.
I am an employer and want coverage to be available to dependents of my employees up to age 29. what should i do?
If you are an employer and want the make available benefit, you should contact your insurer for information about this benefit. You will need to purchase a rider to extend the age of dependent coverage.
do employers have to provide the provisioning benefit?
not. 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 priority 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 option of making available 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 ny health?
the make available option is available for coverage through a healthy ny group policy.
Are there other insurance plans to which this law does not apply?
The law does not apply to dental coverage only, vision only, pharmacy only, accident only, or specific diseases.
I have a son. Does this make me ineligible?
See also : Coordination of Benefits | CMS
not. young adults with children may be covered through the make available option if they meet the eligibility criteria. however, children of young adults cannot be covered under the “age 29” law. If you need to cover your children, you may want to consider Child Health Plus. child health plus is available at a reduced premium for children in families 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 qualify for employer-sponsored coverage, but it has very few benefits. Am I eligible?
If your employer provides comprehensive insurance that includes medical and hospital benefits, you may not be able to get coverage through the make available option. If your employer provides coverage that doesn’t include medical and hospital benefits, then you may be eligible if you meet the other requirements.
If I exhaust my benefits under the “29 years” law, can I elect state continuation coverage or collect and receive an additional 36 months of coverage?
If you are covered through the roll-out option, you would be eligible to elect state or collect continuation coverage, if you meet the criteria for state or collect continuation.
What options do I have if my parents’ employer doesn’t offer me this benefit?
If you are currently covered as a dependent through a parent’s policy, but are approaching the maximum age of dependency, you may be able to elect state/cobra 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 may be covered until age 29, as long as you meet the eligibility requirements.
I am covered through an individual policy that I purchased on my own. can I still get coverage through the provisioning option?
If you are covered as an individual, you may be able to obtain coverage through the provisioning option if you meet the eligibility requirements. If you have coverage through your employer, then you can’t get coverage through the roll-over option, because you have employer-sponsored insurance.
If my parent’s employer offers several different benefit packages, can I 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 end your coverage under the terms of the policy.
- Your parent’s coverage ends.
- You no longer meet the eligibility requirements.
- the insurance policy is terminated and is not replaced.
If I exhaust my benefits under the roll-over option, can I elect state continuation coverage and/or collect and receive an additional 36 months of coverage?
if you are covered through the roll-out option, then you may elect state/cobra continuation coverage for up to 36 months, assuming you meet the criteria for state/cobra 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 Consumer Assistance Unit at (212) 480-6400 or 1-800-342-3736.