Ohio Code 1751.14 – Termination of coverage of child
(A) Notwithstanding section 3901.71 of the Revised Code, any policy, contract, or agreement for health care services authorized by this chapter that is issued, delivered, or renewed in this state and that provides that coverage of an unmarried dependent child will terminate upon attainment of the limiting age for dependent children specified in the policy, contract, or agreement, shall also provide in substance both of the following:
Terms Used In Ohio Code 1751.14
- Child: includes child by adoption. See Ohio Code 1.59
- Continuance: Putting off of a hearing ot trial until a later time.
- Contract: A legal written agreement that becomes binding when signed.
- Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
- Corporation: means a corporation formed under Chapter 1701. See Ohio Code 1751.01
- Dependent: A person dependent for support upon another.
- Health care services: means basic, supplemental, and specialty health care services. See Ohio Code 1751.01
- Health insuring corporation: means a corporation, as defined in division (H) of this section, that, pursuant to a policy, contract, certificate, or agreement, pays for, reimburses, or provides, delivers, arranges for, or otherwise makes available, basic health care services, supplemental health care services, or specialty health care services, or a combination of basic health care services and either supplemental health care services or specialty health care services, through either an open panel plan or a closed panel plan. See Ohio Code 1751.01
- Specialty health care services: means one of the supplemental health care services listed in division (B) of this section, when provided by a health insuring corporation on an outpatient-only basis and not in combination with other supplemental health care services. See Ohio Code 1751.01
- state: means the state of Ohio. See Ohio Code 1.59
- Subscriber: means a person who is responsible for making payments to a health insuring corporation for participation in a health care plan, or an enrollee whose employment or other status is the basis of eligibility for enrollment in a health insuring corporation. See Ohio Code 1751.01
- Supplemental health care services: means any health care services other than basic health care services that a health insuring corporation may offer, alone or in combination with either basic health care services or other supplemental health care services, and includes:
(a) Services of facilities for intermediate or long-term care, or both;
(b) Dental care services;
(c) Vision care and optometric services including lenses and frames;
(d) Podiatric care or foot care services;
(e) Mental health services, excluding diagnostic and treatment services for biologically based mental illnesses;
(f) Short-term outpatient evaluative and crisis-intervention mental health services;
(g) Medical or psychological treatment and referral services for alcohol and drug abuse or addiction;
(h) Home health services;
(i) Prescription drug services;
(j) Nursing services;
(k) Services of a dietitian licensed under Chapter 4759 of the Revised Code;
(l) Physical therapy services;
(m) Chiropractic services;
(n) Any other category of services approved by the superintendent of insurance. See Ohio Code 1751.01
(1) Once an unmarried child has attained the limiting age for dependent children, as provided in the policy, contract, or agreement, upon the request of the subscriber, the health insuring corporation shall offer to cover the unmarried child until the child attains twenty-six years of age if all of the following are true:
(a) The child is the natural child, stepchild, or adopted child of the subscriber.
(b) The child is a resident of this state or a full-time student at an accredited public or private institution of higher education.
(c) The child is not employed by an employer that offers any health benefit plan under which the child is eligible for coverage.
(d) The child is not eligible for coverage under the medicaid program or the medicare program.
(2) That attainment of the limiting age for dependent children shall not operate to terminate the coverage of a dependent child if the child is and continues to be both of the following:
(a) Incapable of self-sustaining employment by reason of physical disability or intellectual disability;
(b) Primarily dependent upon the subscriber for support and maintenance.
(B) Proof of incapacity and dependence for purposes of division (A)(2) of this section shall be furnished to the health insuring corporation within thirty-one days of the child’s attainment of the limiting age. Upon request, but not more frequently than annually, the health insuring corporation may require proof satisfactory to it of the continuance of such incapacity and dependency.
(C) Nothing in this section shall do any of the following:
(1) Require that any policy, contract, or agreement offer coverage for dependent children or provide coverage for an unmarried dependent child’s children as dependents on the policy, contract, or agreement;
(2) Require an employer to pay for any part of the premium for an unmarried dependent child that has attained the limiting age for dependents, as provided in the policy, contract, or agreement;
(3) Require an employer to offer health insurance coverage to the dependents of any employee.
(D)(1) Except as provided in division (D)(2) of this section, this section does not apply to any health insuring corporation policy, contract, or agreement offering only supplemental health care services or specialty health care services.
(2) This section applies to health insuring corporation policies, contracts, or agreements providing coverage of dental care or vision care services that are issued, renewed, or amended on or after January 1, 2024.
(E) As used in this section, “health benefit plan” has the same meaning as in section 3924.01 of the Revised Code and also includes both of the following:
(1) A public employee benefit plan;
(2) A health benefit plan as regulated under the “Employee Retirement Income Security Act of 1974,” 29 U.S.C. § 1001, et seq.
Last updated October 3, 2023 at 9:22 AM