The Pennsylvania legislature recently adopted a measure which permits employers, including school districts, to expand the health insurance coverage available to employees’ children.  Act 4 of 2009, signed into law in October of 2009 and effective January 1, 2010, requires that any insurer issuing a group health insurance contract within the Commonwealth of Pennsylvania must offer an option to the policy holder to extend the term of coverage available to employees’ children.

Specifically, policy holders can now elect whether to modify their health insurance contract to offer employees, at the employee’s own expense, coverage for an employee’s child extending through the year the child is twenty-nine (29) years old, provided that the child is (1) not married, (2) has no dependents, (3) is a Pennsylvania resident or a full-time student in an institution of higher education, and (4) is not covered by any other group health insurance policy or eligible to receive benefits under any government health care program, including Social Security.  Under the Act, insurance companies are permitted to determine the increase in premiums related to extending coverage for an employee’s child from the age of 19 through the age of 29, with that increase to be borne by the employee choosing the coverage.  To avoid any confusion, employee payment requirements should be clarified with each employee groups’ Union.  The additional rights to elect insurance granted under Act 4 of 2009 do not apply to certain policies, such as hospital indemnity insurance, accident insurance, certain specified disease insurances, disability income insurance, dental insurance, vision insurance and other types of insurance.

Thus, beginning in 2010, when entering into a new health insurance contract or renewing an old one, districts have the option to direct their insurers to provide extended coverage for employees’ children so that they will be covered through the age of 29, with electing employees paying for the additional premium amounts incurred by this extension.  It is also important to note that there is nothing in Act 4 of 2009 which requires employers to provide this extended health care coverage, and nothing requires employees to buy coverage for their children for an extended time if the employer chooses to have the health care insurer provide it.  In short, the new Act merely provides an opportunity for employers to elect whether or not this option will be made available to employees by insurers.  Depending on the circumstances and employee interest, it may be worthwhile for your District to explore this possibility with your insurer.

Alfred Maiello

Alfred C. Maiello is the founding member of MBM and has represented area school districts as solicitor for 50 years. He counsels school districts and educational institutions on leading developments in school law and guiding them through their day-to-day and long-term challenges.