N.Y. Attorney General, EmblemHealth Reach Settlement Over Continuation Coverage

In a press release, Attorney General Eric Schneiderman announced that his office had conducted an investigation into widespread violations of New York’s Age 29 Law, which requires health insurers to offer young adults continuation health coverage on their parents’ policies until they turn 30. Following the investigation, a settlement was reached with the health insurer requiring it to reinstatement health coverage to more than 8,000 young adults whose coverage was wrongly terminated, and to pay approximately $90,000 in denied claims.

The federal Affordable Care Act provides that families can keep their children on their family health policy until the child turns 26, while New York’s law is even more protective and ensures that families can continue to cover their children until they turn 30. New York’s Age 29 Law, was enacted in 2009, and requires insurers to provide: “(i) written notification to group members in each certificate of coverage regarding the right to purchase continuation coverage for their adult children within sixty (60) days after termination of the adult child’s coverage, within sixty (60) sixty days after qualifying as an adult child, or during an annual thirty (30) day open enrollment period; and (ii) written notice of an upcoming termination date at least sixty (60) days prior to the date the young adult covered under the parent’s policy would have coverage terminate due to reaching the maximum age for coverage.” N.Y. Ins. Law. §§ 3221(r)(2)(G); 4305(l)(2)(G).

The investigation revealed that the health insurer had failed to send statutorily required letters to more than 8,000 members between 2010 and 2012. Of these members, almost 1,000 were not even notified that their coverage had been terminated. Additionally, as part of the settlement, the health insurer will submit to monitoring and an independent audit, and will pay $100,000 as a civil penalty.

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