Extending health coverage to members 26 and younger

In advance of this new reform requirements implementing this fall, Providence Health Plan will allow currently insured individuals age 26 or younger to remain on a parent’s employer-offered or individual and family health plan policy. This extension applies to Providence Health Plan members who currently have coverage and would lose that coverage during the gap between June 1 and the effective date of the new law, Sept. 23, 2010.

This change is effective for members of:

  • Providence Health Plan individual and family plan
  • Providence Health Plan commercial fully insured
  • Providence Health Plan Oregon portability and Washington conversion
  • Providence Health Plan state continuation or COBRA

Reform for Employers may choose to opt-out of the early implementation of this rule. This change does not apply to Oregon Health Plan or Medicare Advantage members.

This applies only to those who would normally age-out June 1, 2010 or after, based on their policy. This change standardizes the age-out to 26 years. Unfortunately, those who aged out prior to June 1, 2010 are not eligible for re-instatement.

In order to remain on the policy, the member does not need to do anything. If they wish to disenroll, they need to contact their employer or contact Providence Health Plan directly for individual or portability plans.

For more information, read our frequently asked questions below, contact your employer benefits department or call Providence Health Plan customer service at 503-574-7500 or 800-878-4445, Monday through Friday, 8 a.m. to 5 p.m.

Frequently asked questions

Why is Providence Health Plan making this change?

We recognize that extending coverage to young adults, required to take place in September, may adversely affect many adult dependents that are just graduating now, or otherwise not currently insured this summer. We hope to make it easy for these affected members to continue coverage, with minimal disruption to everyone including members and employers.

If I am under 26, am I automatically kept on a parent’s policy? Or do I have to take action to stay on?

You will not have to take any action.

If the subscriber (a parent) wants to disenroll the dependent member, they will need to disenroll through their employer if it is an employer group policy or by contacting customer service for an individual or portability plan member.

If my dependent aged out before June 1, can he or she be reinstated immediately?

No. Unfortunately, those who aged out prior to June 1 are not eligible for dependent coverage under the new reform mandate until your employer’s next open enrollment period.

How is the age calculated for turning 26? Is it the member’s actual birthday?

The member would be disenrolled at the end of month in which they turned 26.

What if the child has their own child or children? Can I enroll grandchildren as well?

A grandchild cannot be added as a result of this rule on June 1; the June 1 date simply postpones the aging-out for grown children but not to add new dependent members.

A grandchild may be covered, regardless of whether their parent is covered as an adult dependent or not, if they meet the eligibility requirement as follows: A grandchild for whom the subscriber or the subscriber’s spouse provides at least 50 percent support.

Does a dependent need to be single?

A covered dependent child can be married only after the new rules go into effect, which is renewal after Sept. 23, 2010. However, a dependent child’s spouse or domestic partner is not eligible for enrollment on the policy.

Is it less expensive for me to stay on a parent’s policy or to buy my own policy?

That depends on the policy and benefits you have available through your parent, what the parent pays for their coverage, etc. You could instead choose to apply for a Providence individual and have your own policy. You could then stay on this plan even after age 26. This plan does subject an applicant to a health screen.

What if my employer covers part or all of the premium payments for employees and their dependents? Will my employer need to authorize this early start to the under 26?

The employer would continue to cover all or part, but employers may choose to opt out of the early implementation. This extends coverage to age 26 only for currently enrolled dependents. Employers could choose not to support the early start to this implementation by sending Providence Health Plan an updated termination list of covered members. However, by federal reform law, the employers must comply with the under 26 rule at their next health plan contract renewal after Sept. 23, 2010.

Can my dependent be billed separately for their premium?

No. Unfortunately, our systems do not support that.

Can the premium payment be made by credit card?

The entire premium can be paid by credit card for all enrolled members on the individual and family plan and the portability plan, however, the members must pay the monthly bill in entirety, not just a partial payment.

Those on employer plans do not pay Providence Health Plan directly.

Does a child need to be living at home to be included?

No.

Does a child need to be in school?

No.

Does my disabled children age off at 26 now too?

No, incapacitated dependents meeting requirements for enrollment do not have an age limit.