New York insurer agrees to reinstate offspring coverage
ALBANY A New York insurer has agreed to reinstate health coverage for up to 8,300 young adults who were dropped from their parents' policies before they turned 30.
Under an agreement with the state attorney general, EmblemHealth Inc. also said it will pay approximately 175 claims for about $90,000 for unreimbursed medical treatment.
While federal law authorizes keeping children on their parents' health insurance until they turn 26, New York requires insurers to offer that continuing coverage until age 30. The agreement signed this week also requires EmblemHealth to pay the attorney general $100,000 as a civil penalty.
"The people of New York recognize that young adults need affordable, quality health coverage, and that includes having the option to stay on their parents' insurance through their 20s," Attorney General Eric Schneiderman said. "Providing health coverage to New Yorkers also means playing by the rules and following the laws of our state, which are often stronger than federal regulations."
The company didn't immediately reply to requests for comment Wednesday.
EmblemHealth covers 3.4 million New Yorkers through Group Health Incorporated and Health Insurance Plan of Greater New York, the attorney general's office said. The investigation showed it failed to send letters to more than 8,000 members from 2010 to 2012 notifying them of their rights to buy continuing coverage for their offspring, while 1,000 were never notified coverage had been terminated, according to investigators.
The probe and settlement followed a complaint filed by an insured parent whose daughter's health benefits in HIP were denied after her coverage was terminated when she turned 26, according to Schneiderman's office. The mother had to pay $1,000 out of pocket for her daughter's medical treatment and faced additional bills of $4,000.
Under the agreement, EmblemHealth said it will pay claims by members whose coverage was terminated without required notice and who now claim medical expenses they incurred, unless they were reimbursed by other insurance. New York passed the law to extend offspring coverage in 2009.