Wire
Disabled adult children could keep coverage after 26 in New Jersey
The New Jersey bill would keep some adult children on a parent’s health plan if a physical or intellectual disability leaves them unable to support themselves. It also spells out how claims work when the policy runs through a noncustodial parent.
In New Jersey, turning 26 can still mean losing the insurance that has kept a disabled adult child in treatment, medication and steady care. A proposal in the state would require insurers and health plans that already offer dependent coverage to keep that coverage available beyond 26 for some adult children with physical or intellectual disabilities.
The bill does not create a new insurance program. It amends the state’s existing dependent-coverage rules, which already keep children on a parent’s plan through age 26, and adds a narrow exception for families that still need that coverage after the birthday cutoff.
The coverage test is strict
The protection would not apply to every adult child with a disability. Under the bill, the child would have to be incapable of self-sustaining employment because of the disability, chiefly dependent on the subscriber for support and maintenance, disabled before reaching the plan’s age limit and continuously insured once that limit was reached. In hospital service corporation contracts, the coverage would continue until the child turns 26, but for managed care plans the child would still have to follow the contract terms on using specified providers.
The measure also says insurers could not turn away a child for reasons that often have nothing to do with medical need: being born out of wedlock, not being claimed on a federal tax return, living elsewhere, being married, starting or leaving school, or having or adopting a child.
Claims would not get stuck with the wrong parent
The bill also deals with a family problem that can become its own obstacle course. If coverage runs through a noncustodial parent, the insurer would have to give the custodial parent the information needed to secure benefits, and it would have to let the custodial parent, or a provider authorized by that parent, submit claims without the noncustodial parent’s approval.
Payments on those claims could go directly to the custodial parent, the health care provider or the state Medicaid agency, depending on the situation. For families already juggling appointments, bills and paperwork, the point is to keep coverage usable when the child still depends on it.