Public Act 95-958, approved in September of 2008 and effective June 1, 2009, establishes new requirements for dependent health insurance coverage in Illinois. The Act adds two new sections to the Illinois Insurance Code (215 ILCS 5/1 et seq.). Section 356z.11 (215 ILCS 5/356z.11) requires dependent student coverage to continue if the student takes a medical leave of absence or becomes enrolled on a part-time basis because of a catastrophic illness or injury. Section 356z.12 (215 ILCS 5/356z.12) requires certain health insurance policies to include an option for dependent coverage up to age 26, or up to age 30 for military veteran dependents. The Act also amends the State Employees Group Insurance Act of 1971 (5 ILCS 375/1), the Counties Code (55 ILCS 5/1‑1001), the Municipal Code (65 ILCS 5/1‑1‑1), and the School Code (105 ILCS 5/1‑1), to make the new dependent coverage requirements applicable to entities governed by those laws. Although employers must provide this extended coverage, they are not required to pay any of the cost of coverage required under Public Act 95-958.

Dependent student leaves of absence

Under new Section 356z.11 of the Insurance Code, health insurance policies delivered, issued, or renewed after June 1, 2009 must continue to provide coverage for dependent college students who can only enroll part-time because of catastrophic injuries or illnesses. Additionally, coverage must continue for college students who take medical leaves of absence because of catastrophic injuries or illnesses.

The statute does place some limitations on this continued coverage requirement, and all of a given policy’s terms and conditions will apply to the continuation of dependent student coverage. Additionally, the contin- uation of coverage is limited to a maximum of 12 months. Under the statute, the continued coverage “shall terminate 12 months after notice of the illness or injury or until the coverage would have otherwise lapsed pursuant to the terms and conditions of the policy, whichever comes first.” Finally, dependent students are required to provide physicians’ certifications of the need for part-time status or medical leaves of absence.

Expanded dependent coverage

New Section 356z.12 adds several provisions to the Insurance Code which establish expanded age limits for dependent coverage. Specific age limitations apply to unmarried military veteran dependents and all other unmarried dependents. This new section also creates requirements for dependent health insurance enrollment periods, as well as specifying other requirements related to expanded dependent coverage.

New age limitations – Health insurance policies amended, delivered, issued or renewed after June 1, 2009 must not terminate coverage or deny the election of coverage because of a dependent’s age, before the dependent’s 26th birthday. For unmarried military veteran dependents, coverage cannot be terminated or denied before the dependent’s 30th birthday. It is important to note the new statutory language only prohibits termination or denial of coverage because of a dependent’s age. Other limitations imposed under a given policy are not impacted by this requirement.

Military personnel requirements – To be eligible for coverage until age 30, a military veteran dependent must (1) be an Illinois resident; (2) have served as a member of the active or reserve components of any of the branches of the Armed Forces; and (3) have received a release or discharge other than a dishonorable discharge. Military veteran dependents are required to submit an approved form to the insurer stating the date of release from service.

Initial enrollment periods – New Section 356z.12 also details the requirements and limitations for initial and annual enrollment periods. Regarding initial enrollment, policies amended, delivered, issued or renewed after June 1, 2009 must allow a 90-day enrollment period for eligible dependents. A policy’s normal enrollment terms will apply after that initial 90-day enrollment period. According to the Illinois Department of Insurance, eligible dependents may not be excluded during an initial 90-day enrollment period because of creditable coverage issues, continuous coverage issues, or breaks in coverage. Also according to the Department of Insurance, the initial 90-day enrollment provisions apply from June 1, 2009 through May 31, 2010.

Annual enrollment – Policies subject to Public Act 95-958 may condition the election of dependent coverage during annual open enrollment periods on two requirements. First, coverage may be denied if the dependent does not have a period of continuous coverage of at least 90 days. Second, coverage may be denied if the dependent has been without creditable coverage for more than 63 days.