New York Fleshes Out Young Adult Coverage Rules

A young adult can get coverage through that mechanism even if the young adult qualifies for Consolidated Omnibus Budget Reconciliation Act health benefits continuation coverage from a former employer, officials write.

“With regard to community-rated policies, the premium for the young adult option must be the group rate for one person under the group policy or contract,” officials write.

Employers and carriers cannot charge an additional 2% administrative fee, as they would for COBRA coverage.

When setting rates for coverage sold through the “make available option,” an insurer should submit a rate filing to the New York department for review, officials say.

“With regard to group and group remittance polices and contracts, an insurer should spread the cost of the coverage among all group or group remittance members with family coverage and not just among the eligible young adults,” officials write.

“With regard to individual and small group policies and contracts, community rating rules apply, and an insurer must spread the cost of the make available option across all policy or contract holders in the rating pool who have purchased family coverage that includes the make available option,” officials write.