2023 -- H 5338

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LC000806

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2023

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A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

     Introduced By: Representatives Baginski, Shanley, Dawson, and J. Brien

     Date Introduced: February 03, 2023

     Referred To: House Corporations

     It is enacted by the General Assembly as follows:

     SECTION 1. Section 27-18-59 of the General Laws in Chapter 27-18 entitled "Accident

and Sickness Insurance Policies" is hereby amended to read as follows:

     27-18-59. Eligibility for children’s benefits.

     (a)(1) Every health benefit plan delivered, issued for delivery, or renewed in this state and

every group health insurance contract, plan, or policy delivered, issued for delivery or renewed in

this state which provides health benefits coverage for dependents, except for supplemental policies

which only provide coverage for specified diseases and other supplemental policies, shall make

coverage available for children until attainment of twenty-six (26) thirty (30) years of age, and an

unmarried child of any age who is financially dependent upon the parent and medically determined

to have a physical or mental impairment which can be expected to result in death or which has

lasted or can be expected to last for a continuous period of not less than twelve (12) months.

     (2) With respect to a child who has not attained twenty-six (26) thirty (30) years of age, a

health insurance carrier shall not define “dependent” for purposes of eligibility for dependent

coverage of children other than the terms of a relationship between a child and the plan participant,

or subscriber.

     (3) A health insurance carrier shall not deny or restrict coverage for a child who has not

attained twenty-six (26) thirty (30) years of age based on the presence or absence of the child’s

financial dependency upon the participant, primary subscriber or any other person, residency with

the participant and in the individual market the primary subscriber, or with any other person, marital

status, student status, employment or any combination of those factors. A health carrier shall not

deny or restrict coverage of a child based on eligibility for other coverage, except as provided in

subparagraph (b)(1) of this section.

     (4) Nothing in this section shall be construed to require a health insurance carrier to make

coverage available for the child of a child receiving dependent coverage, unless the grandparent

becomes the legal guardian or adoptive parent of that grandchild.

     (5) The terms of coverage in a health benefit plan offered by a health insurance carrier

providing dependent coverage of children cannot vary based on age except for children who are

twenty-six (26) thirty (30) years of age or older.

     (b)(1) For plan years beginning before January 1, 2014, a health insurance carrier providing

group health insurance coverage that is a grandfathered health plan and makes available dependent

coverage of children may exclude an adult child who has not attained twenty-six (26) thirty (30)

years of age from coverage only 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 federal Internal Revenue

Code, other than the group health plan of a parent.

     (2) For plan years, beginning on or after January 1, 2014, a health insurance carrier

providing group health insurance coverage that is a grandfathered health plan shall comply with

the requirements of subsections (a) through (e) of this section.

     (c) This section does not apply to insurance coverage providing benefits for: (1) hospital

confinement indemnity; (2) disability income; (3) accident only; (4) long term care; (5) Medicare

supplement; (6) limited benefit health; (7) specified diseased indemnity; or (8) sickness or bodily

injury or death by accident or both; or (9) other limited benefit policies.

     SECTION 2. Section 27-19-50 of the General Laws in Chapter 27-19 entitled "Nonprofit

Hospital Service Corporations" is hereby amended to read as follows:

     27-19-50. Eligibility for children’s benefits.

     (a)(1) Every health benefit plan delivered, issued for delivery, or renewed in this state

which provides health benefits coverage for dependents, except for supplemental policies which

only provide coverage for specified diseases and other supplemental policies, shall make coverage

available for children until attainment of twenty-six (26) thirty (30) years of age, and an unmarried

child of any age who is financially dependent upon the parent and medically determined to have a

physical or mental impairment which can be expected to result in death or which has lasted or can

be expected to last for a continuous period of not less than twelve (12) months.

     (2) With respect to a child who has not attained twenty-six (26) thirty (30) years of age, a

health insurance carrier shall not define “dependent” for purposes of eligibility for dependent

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coverage of children other than the terms of a relationship between a child and the plan participant

or subscriber.

     (3) A health insurance carrier shall not deny or restrict coverage for a child who has not

attained twenty-six (26) thirty (30) years of age based on the presence or absence of the child’s

financial dependency upon the participant, primary subscriber or any other person, residency with

the participant and in the individual market the primary subscriber, or with any other person, marital

status, student status, employment or any combination of those factors. A health carrier shall not

deny or restrict coverage of a child based on eligibility for other coverage, except as provided in

(b)(1) of this section.

     (4) Nothing in this section shall be construed to require a health insurance carrier to make

coverage available for the child of a child receiving dependent coverage, unless the grandparent

becomes the legal guardian or adoptive parent of that grandchild.

     (5) The terms of coverage in a health benefit plan offered by a health insurance carrier

providing dependent coverage of children cannot vary based on age except for children who are

twenty-six (26) thirty (30) years of age or older.

     (b)(1) For plan years beginning before January 1, 2014, a group health plan providing

group health insurance coverage that is a grandfathered health plan and makes available dependent

coverage of children may exclude an adult child who has not attained twenty-six (26) thirty (30)

years of age from coverage only 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 federal Internal Revenue

Code, other than the group health plan of a parent.

     (2) For plan years, beginning on or after January 1, 2014, a group health plan providing

group health insurance coverage that is a grandfathered health plan shall comply with the

requirements of this section.

     (c) This section does not apply to insurance coverage providing benefits for: (1) Hospital

confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare

supplement; (6) Limited benefit health; (7) Specified diseased indemnity; or (8) Other limited

benefit policies.

     SECTION 3. Section 27-20-45 of the General Laws in Chapter 27-20 entitled "Nonprofit

Medical Service Corporations" is hereby amended to read as follows:

     27-20-45. Eligibility for children’s benefits.

     (a)(1) Every health benefit plan delivered, issued for delivery, or renewed in this state

which provides health benefits coverage for dependents, except for supplemental policies which

only provide coverage for specified diseases and other supplemental policies, shall make coverage

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available for children until attainment of twenty-six (26) thirty (30) years of age, and an unmarried

child of any age who is financially dependent upon the parent and medically determined to have a

physical or mental impairment which can be expected to result in death or which has lasted or can

be expected to last for a continuous period of not less than twelve (12) months.

     (2) With respect to a child who has not attained twenty-six (26) thirty (30) years of age, a

nonprofit medical service corporation shall not define “dependent” for purposes of eligibility for

dependent coverage of children other than the terms of a relationship between a child and the plan

participant or subscriber.

     (3) A nonprofit medical service corporation shall not deny or restrict coverage for a child

who has not attained twenty-six (26) thirty (30) years of age based on the presence or absence of

the child’s financial dependency upon the participant, primary subscriber or any other person,

residency with the participant and in the individual market the primary subscriber, or with any other

person, marital status, student status, employment or any combination of those factors. A nonprofit

medical service corporation shall not deny or restrict coverage of a child based on eligibility for

other coverage, except as provided in (b)(1) of this section.

     (4) Nothing in this section shall be construed to require a health insurance carrier to make

coverage available for the child of a child receiving dependent coverage, unless the grandparent

becomes the legal guardian or adoptive parent of that grandchild.

     (5) The terms of coverage in a health benefit plan offered by a nonprofit medical service

corporation or providing dependent coverage of children cannot vary based on age except for

children who are twenty-six (26) thirty (30) years of age or older.

     (b)(1) For plan years beginning before January 1, 2014, a group health plan providing

group health insurance coverage that is a grandfathered health plan and makes available dependent

coverage of children may exclude an adult child who has not attained twenty-six (26) thirty (30)

years of age from coverage only 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 federal Internal Revenue

Code, other than the group health plan of a parent.

     (2) For plan years, beginning on or after January 1, 2014, a health insurance carrier

providing group health insurance coverage that is a grandfathered health plan shall comply with

the requirements of this section.

     (c) This section does not apply to insurance coverage providing benefits for: (1) hospital

confinement indemnity; (2) disability income; (3) accident only; (4) long-term care; (5) Medicare

supplement; (6) limited benefit health; (7) specified diseased indemnity; or (8) other limited benefit

policies.

LC000806 - Page 4 of 7

     SECTION 4. Section 27-41-61 of the General Laws in Chapter 27-41 entitled "Health

Maintenance Organizations" is hereby amended to read as follows:

     27-41-61. Eligibility for children’s benefits.

     (a)(1) Every health benefit plan delivered, issued for delivery, or renewed in this state

which provides health benefits coverage for dependents, except for supplemental policies which

only provide coverage for specified diseases and other supplemental policies, shall make coverage

available for children until attainment of twenty-six (26) thirty (30) years of age, and an unmarried

child of any age who is financially dependent upon the parent and medically determined to have a

physical or mental impairment which can be expected to result in death or which has lasted or can

be expected to last for a continuous period of not less than twelve (12) months.

     (2) With respect to a child who has not attained twenty-six (26) thirty (30) years of age, a

health maintenance organization shall not define “dependent” for purposes of eligibility for

dependent coverage of children other than the terms of a relationship between a child and the plan

participant, or subscriber.

     (3) A health maintenance organization shall not deny or restrict coverage for a child who

has not attained twenty-six (26) thirty (30) years of age based on the presence or absence of the

child’s financial dependency upon the participant, primary subscriber or any other person,

residency with the participant and in the individual market the primary subscriber, or with any other

person, marital status, student status, employment or any combination of those factors. A health

carrier shall not deny or restrict coverage of a child based on eligibility for other coverage, except

as provided in (b)(1) of this section.

     (4) Nothing in this section shall be construed to require a health maintenance organization

to make coverage available for the child of a child receiving dependent coverage, unless the

grandparent becomes the legal guardian or adoptive parent of that grandchild.

     (5) The terms of coverage in a health benefit plan offered by a health maintenance

organization providing dependent coverage of children cannot vary based on age except for

children who are twenty-six (26) thirty (30) years of age or older.

     (b)(1) For plan years beginning before January 1, 2014, a group health plan providing

group health insurance coverage that is a grandfathered health plan and makes available dependent

coverage of children may exclude an adult child who has not attained twenty-six (26) thirty (30)

years of age from coverage only 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 federal Internal Revenue

Code, other than the group health plan of a parent.

     (2) For plan years, beginning on or after January 1, 2014, a group health plan providing

LC000806 - Page 5 of 7

group health insurance coverage that is a grandfathered health plan shall comply with the

requirements of this section

     (c) This section does not apply to insurance coverage providing benefits for: (1) hospital

confinement indemnity; (2) disability income; (3) accident only; (4) long-term care; (5) Medicare

supplement; (6) limited benefit health; (7) specified diseased indemnity; or (8) other limited benefit

policies.

     SECTION 5. This act shall take effect on on January 1, 2024.

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LC000806

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

***

     This act would allow children to stay covered under the parent's health insurance plan until

the child reaches thirty (30) years of age.

     This act would take effect on January 1, 2024.

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LC000806

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