Chapter 220
2023 -- H 5539
Enacted 06/21/2023

A N   A C T
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

Introduced By: Representatives Casimiro, Noret, Spears, Roberts, Cotter, Diaz, Chippendale, and Morales

Date Introduced: February 15, 2023

It is enacted by the General Assembly as follows:
     SECTION 1. Section 27-18-59 of the General Laws in Chapter 27-18 entitled "Accident
and Sickness Insurance Policies" is hereby amended to read as follows:
     27-18-59. Eligibility for children’s benefits.
     (a)(1) Every health benefit plan delivered, issued for delivery, or renewed in this state and
every group health insurance contract, plan, or policy delivered, issued for delivery, or renewed in
this state which that provides health benefits coverage for dependents, except for supplemental
policies which that only provide coverage for specified diseases and other supplemental policies,
shall make coverage available for children, including children under guardianship, until attainment
of twenty-six (26) years of age, and an unmarried child of any age who is financially dependent
upon the parent and medically determined to have a physical or mental impairment which that can
be expected to result in death or which that has lasted or can be expected to last for a continuous
period of not less than twelve (12) months.
     (2) With respect to a child who has not attained twenty-six (26) years of age, a health
insurance carrier shall not define “dependent” for purposes of eligibility for dependent coverage of
children other than the terms of a relationship between a child and the plan participant, or
subscriber; provided, however, that a child in the care of a court appointed guardian who is a plan
participant or subscriber, shall have rights of eligibility identical to a natural born child of the plan
participant or subscriber.
     (3) A health insurance carrier shall not deny or restrict coverage for a child who has not
attained twenty-six (26) years of age based on the presence or absence of the child’s financial
dependency upon the participant, primary subscriber or any other person, residency with the
participant and in the individual market the primary subscriber, or with any other person, marital
status, student status, employment, or any combination of those factors. A health carrier shall not
deny or restrict coverage of a child based on eligibility for other coverage, except as provided in
subparagraph (b)(1) of this section.
     (4) Nothing in this section shall be construed to require a health insurance carrier to make
coverage available for the child of a child receiving dependent coverage, unless the grandparent
becomes the legal guardian or adoptive parent of that grandchild.
     (5) The terms of coverage in a health benefit plan offered by a health insurance carrier
providing dependent coverage of children cannot vary based on age except for children who are
twenty-six (26) years of age or older.
     (b)(1) For plan years beginning before January 1, 2014, a health insurance carrier providing
group health insurance coverage that is a grandfathered health plan and makes available dependent
coverage of children may exclude an adult child who has not attained twenty-six (26) years of age
from coverage only if the adult child is eligible to enroll in an eligible employer-sponsored health
benefit plan, as defined in section 5000A(f)(2) of the federal Internal Revenue Code, other than the
group health plan of a parent.
     (2) For plan years, beginning on or after January 1, 2014, a health insurance carrier
providing group health insurance coverage that is a grandfathered health plan shall comply with
the requirements of subsections (a) through (e) of this section.
     (c) This section does not apply to insurance coverage providing benefits for: (1) hospital
Hospital confinement indemnity; (2) disability Disability income; (3) accident Accident only; (4)
long Long-term care; (5) Medicare supplement; (6) limited Limited benefit health; (7) specified
Specified diseased disease indemnity; or (8) sickness Sickness or bodily injury or death by
accident or both; or (9) other Other limited benefit policies.
     SECTION 2. This act shall take effect on January 1, 2024.
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LC001319
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