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News & Events

Dependent Coverage to Age 26 Lifetime & Annual Limits Preventive Services

Effective for plan years beginning or after September 23, 2010, group health plans and health insurers that offer group or individual coverage that cover dependents must allow coverage of dependents on a parent's plan until the dependent's 26th birthday. While this requirement is generally exempt from the grandfather rules, a group health plan that was in existence on March 23, 2010, does not have to make coverage available to an adult child if the child is eligible to enroll in another employer-sponsored group health plan until plan years beginning before January 1, 2014. If you have questions on identifying these eligible dependents or grandfather status click below for more information.
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Ban on Lifetime Limits and Restrictions on Annual Limits

Plans and Insurers may not place lifetime dollar limits on coverage of participants and beneficiaries. This provision applies to both existing and new plans effective for the first plan year beginning on or after September 23, 2010. For plan years beginning on or after September 23, 2010, but before January 1, 2014, a group health plan and health insurance issuer offering group or individual health insurance coverage may establish only a restricted annual limit. For plan years beginning on or after January 1, 2014, annual limits on the dollar value of coverage of participants and beneficiaries are banned. To learn more about Lifetime Limits and Restriction on Annual Limits, click below for more information.
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Preventive Services

Insurers and group health plans must provide coverage without cost-sharing for preventive services. This provision is effective for the first plan year beginning on or after September 23, 2010, but does not apply to plans in existence on March 23, 2010. At a minimum, the coverage must include:

• Evidence-based items or services rated A or B in the current recommendations of the U.S. Preventive Services Task Force

• Immunizations that have in effect a recommendation from the Advisory Committee on Immunizations Practices for the Centers of Disease Control

• For infants, children and adolescents, evidence-informed preventive care and screenings provided for the comprehensive guidelines supported by the Health Resources and Services Administration

• For women, and any additional preventive care and screening provided for in a comprehensive guidelines supported by the Health Resources and Services Administration.

• Much of this information is available through various government publications, if you need direction on determining what services are considered preventive, or would like more information on the provision, simply click below for more information.
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