Section 632.885. Coverage of dependents.

 

(1)   Definitions. In this section:

(af) “Eligible employer-sponsored plan" has the meaning given in 26 USC 5000A (f) (2).

(ar) “Grandfathered health plan" has the meaning given under section 1251 of the Patient Protection and Affordable Care Act ( P.L. 111-148 ).

(at) “Health insurance coverage" has the meaning given in 42 USC 300gg-91 (b) (1).

(b) “Insured" includes an enrollee.

(c) “Self-insured health plan" has the meaning given in s. 632.745 (24) .

(2)   Requirement to offer dependent coverage.

(a) Subject to ss. 632.88 and 632.895 (5) , and except as provided in pars. (b) and (c) , every insurer that offers health insurance coverage that provides dependent coverage of children, and every self-insured health plan that provides dependent coverage of children, shall provide coverage for any child of an applicant or insured as a dependent of the applicant or insured if the child is under the age of 26.

(b) Except as provided in par. (c) , the coverage requirement under this section applies to an adult child who satisfies all of the following criteria:

1. The child is a full-time student, regardless of age.

3. The child was called to federal active duty in the national guard or in a reserve component of the U.S. armed forces while the child was attending, on a full-time basis, an institution of higher education.

4. The child was under the age of 27 years when called to federal active duty under subd. 3.

(c) For any policy year or plan year beginning before January 1, 2014, health insurance coverage or a self-insured health plan described in par. (a) that is a grandfathered health plan is required to provide dependent coverage for an adult child described in par. (a) or (b) only if the child is not eligible for coverage under an eligible employer-sponsored plan other than the health insurance coverage or self-insured health plan.

(3m)   Defining dependent; uniform terms. An insurer or self-insured health plan described in sub. (2) may not do any of the following:

(a) Define “dependent" for purposes of eligibility for dependent coverage of children other than in terms of the relationship between a child and an applicant or insured.

(b) Vary the terms of coverage under the health insurance coverage or self-insured health plan on the basis of age except for children 26 years of age or older.

2009 a. 28 ; 2011 a. 32 . Cross-reference: See also s. Ins 3.34 , Wis. adm. code.