Wisconsin issues rule expanding health insurance coverage to young adults

Wisconsin Governor Jim Doyle has announced an emergency rule from the Office of the Commissioner of Insurance (OCI) implementing a new state law expanding health insurance coverage for young adults under age 27. Young adults will be able to receive coverage through their parents’ health care plans.

This emergency rule ensures that young adults, a group that traditionally has high levels of uninsurance, will have access to affordable health insurance coverage through their parents, Governor Doyle said. Questions were raised regarding provisions of the new law. The rule provides needed clarity to ensure eligible young adults have quick access to heath care coverage.

The emergency rule clarifies a new law, passed in June 2009, requiring health insurance policies to cover eligible young adults up to age 27. The law applies to individual and group health benefit plans and a self-insured plan of the state, or a county, city, village, town or school district, including limited scope plans, such as vision and dental plans.

The rule clarifies:

  • the calculation for eligibility based on premium costs;

  • eligibility for military personnel;

  • eligibility for students;

  • eligibility for non-resident young adults with resident parents; and

  • eligibility for young adults previously dropped from coverage because of their age.

To be eligible for this coverage young adults must be over age 17 but less than 27 years of age; not married; and either ineligible for health coverage through the young adult's employer or have premium contribution for employer coverage that exceed the additional premium amount the parent is required to pay to add the young adult to the parent’s health plan.

Additional eligibility rules apply to young adults who are called to federal active duty in the National Guard or reserves while a full-time student. The statute goes into effect for health insurance policies issued or renewed beginning on January 1, 2010.

The emergency rule can be viewed at OCI’s website at http://oci.wi.gov/rules/0334em09.pdf

Reprinted with permission. © CCH
(Submitted Nov. 3, 2009)

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