For Insured Employees With Dependent Coverage, Does the Deductible for Each Person Have to be Satisfied Before Reimbursement Begins?

A group health insurance plan provides coverage for individual members of any organization, including employees of a certain business or company. It brings mutual benefits, both for the insurance company offering it, and the group itself with its individual members.

Insured employees of a certain group plan are allowed dependent coverage. The United States has its Affordable Care Act that allows young adults to remain under their parents’ or guardians’ health care plan until they reach the age of twenty-six. This regulation declares that young adults are eligible for this coverage regardless of factors such as dependency on finances, residency with parents, status of the students, marital status, as well as employment. This is relevant to all plans in the individual market, and to group plans established after the date of enactment, which surprisingly was just made last March 23, 2010. For group plans that were in existence before the enactment date, young adults may qualify for dependent coverage only if they are not suited for a health insurance plan that is employment-based until the year 2014. From that year, young adults can choose to stay under their parents’ health care plan until the age of twenty-six or until they are allowed to be included in an employment-based or group-based health insurance plan.

This is also a law which does not require the insurance company to offer a coverage that is dependent. However, if coverage is offered, it must be extended to young adults until the age of twenty-six.

This is also a new law that applies in all states. They may continue with the current state law requisites for extended dependent coverage, unless they prevent the application of the Patient Protection and Affordable Care Act.

As sponsors of various coverage plans, state and local governments need to notify those who are under the age of twenty-six, whose coverage have ended, or who were denied enrollment under their plans before turning into the said age. The coverage for young adults up to the mentioned age limit was in effect since Sept. 23, 2010.

The cost for notifying families of new opportunities for enrollment will be shared between the insurance providers and groups. The cost of covering the adults who avail of the extension will be shared between the group or employers and the families of young adults who will be newly covered. The states will also share the families’ costs. The young adult who is deemed qualified cannot be required to make more payments for coverage than individuals who did not lose coverage because of the loss of dependent status.

Each person covered under a group health insurance plan must carry out a deductible before expenses will be covered. At any rate, plans usually involve some kind of deductible from the family to limit a family’s exposure to the expenses of health care. The deductible from a family is oftentimes some multiple of the deductible of an individual, generally two or three. In order to come up with the deductible, the integrated expenses of the family members who are covered under the plan are collected. Other plans require, however, that at least one family member satisfies the individual deductible in full before the family deductible can be met.