Inger Williams, OCI Services
Phone: (608) 264-8110
Address: 125 South Webster Street — 2nd Floor
Madison WI 53703-3474
Mail: PO Box 7873, Madison, WI 53707-7873
Analysis Prepared by the Office of the Commissioner of Insurance (OCI)
Statutes interpreted
Statutory authority
Explanation of agency authority
The commissioner is authorized by s.
601.41, Stats., to propose rules in accordance with s.
227.11 (2), Stats., in order for the commissioner to administer and enforce the insurance statutes. Since passage of
2009 Wis. Act 28, the commissioner has been made aware of dramatic differences in interpretation and approaches to implementation that necessitate rule making.
Related statutes or rules
None.
Plain language analysis
The proposed rule interprets and implements the requirements of s.
632.885, Stats., by clarifying and defining eligibility criteria and providing guidance as to how insurers and self-insured health plans are to determine an adult child's eligibility for coverage. The proposed rule clarifies that the mandate applies to individual and group health insurance, limited-scope health insurance including vision and dental plans as well as self-insured health plans. The rule also clarifies that this mandate does not apply to certain insurance products including long-term care and Medigap policies. Further, as described in the applicability provisions of
2009 Wis. Act 28, the rule states when the mandate first applies, including the initial applicability for collectively bargained health plans.
The proposed rule provides clarity through definitions of “premium contribution" and “premium amount." The commissioner received the greatest volume of inquiries seeking guidance on how the premium comparison was to be conducted. The proposed rule simplifies and guides insurers and self-insured plans on exactly what is to be compared for this element of eligibility determination.
Guidance is provided regarding to whom an offer of coverage for an eligible adult child is to be given and reinforces the statutory provision that it is only the applicant or the insured who determines whether or not an eligible dependent is added to his or her health plan. The rule further informs insurers and self-insured plans on prohibited practices that would unduly restrict an otherwise eligible dependent from coverage contrary to the intent of the statute.
Specifically the rule provides specific guidance to insurers offering individual health insurance products as compared to insurers or self-insured health plans offering group health insurance coverage. Insurers offering individual health insurance may rate, may utilize pre-existing condition waiting periods and may apply elimination riders to an eligible adult child but may not impose such limitations as coverage would be rendered illusory. Insurers offering group health insurance or limited-scope insurance and self-insured health plans must comply with s.
632.746, Stat., with regards to pre-existing condition waiting periods and application of creditable coverage. The rule also requires insurers and self-insured health plans to treat an eligible adult child as a new entrant and provide annually at least a 30-day enrollment period.
Finally, the rule clarifies s.
632.885 (2) (a) 3. and
(b) 3., Stats. An adult child is an eligible adult child when the child is between the ages of 17 and 27, is not married and who is not eligible for his or her employer sponsored coverage or whose employer does not offer health insurance to its employees. An adult child who has been called to federal active duty is an eligible adult child when a full-time student, less than 27 years of age when called to active duty. The rule clarifies that the adult child will have up to 12 months after completing active duty to apply for full-time student status at an institution of higher education, and that if the adult child is called more than once in four years of the first call to active duty, insurers and self-insured health plans may only use the adult child's age at the time of the first call to active duty when determining eligibility.
Comparison with federal regulations
There is no existing regulation directly related to this new mandate. The federal government, US House and Senate are currently debating health insurance reform and at this time the office is aware that some of the proposals will be revised to contain similar requirements for extending coverage to adult children, but none have passed as of this date.
Comparison of similar rules in adjacent states
Illinois:
215 ILCS 5/356z.12 provides parents with the option of keeping unmarried dependents on their health care insurance up to age 26. Parents with dependents who are veterans can keep dependents on the plans up to age 30. The veterans must be unmarried, must be Illinois residents, and must have received a discharge other than dishonorable. Veterans do not have to be enrolled as full-time students.
Iowa:
Iowa Code § 509.3 and Iowa Code § 514E.7 requires that health insurance providers continue to cover unmarried children under their parents' coverage provided that the child: 1) is under the age of 25 and a current resident of Iowa, 2) is a full-time student, or 3) has a disability. Iowa Code § 509A.13.B, effective July 1, 2009, allows reenrollment of the same children in previously existing coverage under certain circumstances.
Michigan:
No comparable regulations found. Michigan Code §
500.3406g prohibits the denial of enrollment on certain grounds for plans offering dependent coverage, and §
500.3406h addresses the eligibility of parents for dependent coverage and the health coverage of children through noncustodial parents. §
500.2264 provides exception for the termination of dependent coverage at specified age if a child is incapable of self-support due to mental or physical disability.
Minnesota:
Minnesota Chapter 62E.02 Defines "dependent" as a spouse or unmarried child under age 25, or a dependent child of any age who is disabled.
Ohio:
(information only) Ohio Rev. Code § 1751.14, as amended by 2009 OH H 1 allows an unmarried, dependent child who is an Ohio resident or a full-time student to remain on parent's insurance up to age 28, or without regard to age if they are incapable of self-sustaining employment due to disability.
Summary of factual data and analytical methodologies
The commissioner reviewed existing interpretation of terms used within the new mandate that are used in other areas of the statutes and administrative code for consistency. Further the commissioner considered the intent of the mandate and proposed rules that furthered that intent.
Analysis and supporting documents used to determine rule's effect on small businesses
Although there are some limited-scope health insurers that may meet the definition of a small business, the effect on the insurers will not be significant since insurers will be able to assess and collect premium for the inclusion of the eligible adult child or may apply limitations on coverage. Intermediaries, some of whom may meet the definition of a small business will need to become familiar with this regulation but will not significantly effect those persons.
Small Business Impact
This rule will have little or no effect on small businesses and does not impose any additional requirements on small businesses.
Small Business Regulatory Coordinator
The OCI small business coordinator is Eileen Mallow and may be reached at phone number (608) 266-7843 or at email address
eileen.mallow@wisconsin.gov
Fiscal Estimate
State fiscal effect
None.
State government fiscal effect
None.
Private sector fiscal effect
No significant effect on the private sector regulated by OCI.
Long-range fiscal implications
None.
Agency Contact Person
Inger Williams, OCI Services
Phone: (608) 264-8110
Address: 125 South Webster Street — 2nd Floor
Madison WI 53703-3474
Mail: PO Box 7873, Madison, WI 53707-7873
Notice of Hearing
Public Instruction
NOTICE IS HEREBY GIVEN That pursuant to ss.
115.745 (3) and
227.11 (2) (a), Stats., the Department of Public Instruction will hold a public hearing to consider emergency rules and proposed permanent rules creating Chapter
PI 39, relating to grants for tribal language revitalization. The hearing will be held as follows:
Hearing Information
Date and Time Location
January 15, 2010 Madison
2:30 — 4:00 p.m. GEF 3 Building
125 South Webster Street
Room 041
The hearing site is fully accessible to people with disabilities. If you require reasonable accommodation to access any meeting, please call JP Leary, American Indian Studies Program Consultant, at (608) 267-2283 or leave a message with the Teletypewriter (TTY) at (608) 267-2427 at least 10 days prior to the hearing date. Reasonable accommodation includes materials prepared in an alternative format, as provided under the Americans with Disabilities Act.
Copies of Proposed Rule and Agency Contact Person
Lori Slauson, Administrative Rules and Federal Grants Coordinator
Department of Public Instruction
125 South Webster Street
P.O. Box 7841
Madison, WI 53707
Submission of Written Comments
Written comments on the proposed rules received by Ms. Slauson at the above mail or email address no later than January 22, 2010, will be given the same consideration as testimony presented at the hearing.
Analysis Prepared by the Department of Public Instruction
Statute interpreted
Statutory authority
Explanation of agency authority
Section
115.745 (3), Stats., requires the department to promulgate rules to implement and administer this program.
Section
227.11 (2) (a), Stats., gives an agency rule-making authority to interpret the provisions of any statute enforced or administered by it, if the agency considers it necessary to effectuate the purpose of the statute.
Related statute or rule
N/A
Plain language analysis
2009 Wisconsin Act 28, the biennial budget bill, created a new competitive grant program under s.
115.745, Stats., appropriating $247,500 annually for a school board or cooperative educational service agency (CESA), in conjunction with a tribal education authority to apply to the department for a grant for the purpose of supporting innovative, effective instruction in one or more American Indian languages.
The proposed rule establishes criteria and procedures for awarding grants to eligible applicants. Rules must be in place as soon as possible to award grants in time for the upcoming school year. Therefore, emergency rules were promulgated effective December 15, 2009.
Comparison with federal regulations
N/A
Comparison with rules in adjacent states
