2023 -- H 5539

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LC001319

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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 Casimiro, Noret, Spears, Roberts, Cotter, Diaz,
Chippendale, and Morales

     Date Introduced: February 15, 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, including children under guardianship, until attainment of twenty-

six (26) 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) 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; provided, however that a child in the care of a court appointed guardian who is a plan

participant or subscriber, shall have rights of eligibility identical to a natural born child of 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) 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) 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) 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. This act shall take effect on January 1, 2024.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

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     This act would require insurers to provide coverage to children under court appointed

guardianship of an insured.

     This act would take effect on January 1, 2024.

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LC001319

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