Ohio Continuation of Dental and Vision Coverage for Dependent Children

On June 30, 2023, Ohio approved House Bill 33, which amends existing laws regarding continuation coverage of unmarried, dependent children until age 26, to now include benefit plans providing coverage for dental care or vision services plans (the Ohio law requiring continued coverage for dependents under medical plans has been in effect since October 16, 2009).
 
The requirements herein apply to fully insured and self-funded non-ERISA governmental dental and vision benefit plans that are sponsored by an Ohio employer, offered, issued for delivery, or renewed in Ohio on or after January 1, 2024. 

Requirements

Dental and vision benefit plans that include a termination of coverage provision once an unmarried dependent child reaches the limiting age for dependent children in the plan must also provide the following:

• Once an unmarried child has attained the limiting age for dependent children, as provided in the benefit plan, upon the request of the employee, the benefit plan must offer to cover the unmarried child until the child reaches the age of 26 if all of the following are true:
  • The child is the natural child, stepchild, or adopted child of the insured;
  • The child is a resident of Ohio or a full-time student at an accredited public or private institution of higher education;
  • The child is not employed by an employer that offers any benefit plan under which the child is eligible for coverage; and
  • The child is not eligible for Medicaid or Medicare.

An alternative to offering dependent coverage to age 26 only upon request of the employee, is to have the plan document reflect dependent eligibility to age 26 if the above conditions are met. The client should determine whether they want to offer this extended coverage upon request or whether they want to automatically cover dependent children to age 26 when the above conditions are met.

• The benefit plan should have a process in place for confirming dependent full-time student status or residency status, to qualify for eligibility beyond the normal limiting age.
  • Attainment of the limiting age does not terminate coverage of a dependent child if the child is and continues to be:
    • Incapable of self-sustaining employment by reason of an intellectual disability or physical disability; and
    • Primarily dependent on the covered person for support and maintenance.

• Proof of incapacity and dependence must be furnished by the covered person within 31 days of the child’s attainment of limiting age.
  • Upon request, but not more frequently than annually after the two-year period following the child’s attainment of the limiting age, the benefit plan may require proof of the continuance of such incapacity and dependence.

Limitations

Nothing in the law requires:

• That any benefit plan offer coverage for dependent children or provide coverage for an unmarried dependent child’s children as dependents on the benefit plan;
• The employer to pay for any part of the premium or employee contribution for an unmarried dependent child that has attained the limiting age for dependents, as provided in the benefit plan; or
• The employer to offer coverage to the dependents of any employee.