Must Premiums for Young Adults be the Same as for Other Adults?

February 15, 2011 ( –  This week a reader asks a question about the new dependent child coverage requirements.


Under the PPACA dependent child coverage requirements, are premiums for young adult children (under age 26) required to be the same as for other adults?


The Interim Final Regulation (IFR) governing dependent children coverage to age 26 specifies that the terms of the plan cannot vary based on the age of a child (except for children who are age 26 or older).  The IFR provides examples showing that a plan cannot impose a premium surcharge on certain dependent children based on age and cannot limit what benefit options are available to these dependents.

Please note, however, that in December, the Agencies (HHS, DOL and Treasury) issued a Frequently Asked Question (FAQ) in which they clarified that although this “uniformity” requirement generally prohibits distinctions based upon age in dependent coverage of children, it does not prohibit a plan from making distinctions based upon age that apply to all coverage under the plan, including coverage for employees and spouses as well as dependent children.  In the example used in the FAQ, the plan required copayments for non-preventive care office visits by individuals age 19 and over, including employees, spouses, and dependent children, but waived the copayments for individuals under age 19.  The FAQ stated that the Agencies would not consider this design to violate the requirement.


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You can find a handy list of Key Provisions of the Patient Protection and Affordable Care Act and their effective dates at    


Christy Tinnes is a Principal in the Health & Welfare Group of Groom Law Group in Washington, D.C.  She is involved in all aspects of health and welfare plans, including ERISA, HIPAA portability, HIPAA privacy, COBRA, and Medicare.  She represents employers designing health plans as well as insurers designing new products.  Most recently, she has been extensively involved in the insurance market reform and employer mandate provisions of the health-care reform legislation.  

Brigen Winters is a Principal at Groom Law Group, Chartered, where he co-chairs the firm’s Policy and Legislation group. He counsels plan sponsors, insurers, and other financial institutions regarding health and welfare, executive compensation, and tax-qualified arrangements, and advises clients on legislative and regulatory matters, with a particular focus on the recently enacted health-reform legislation.

PLEASE NOTE:  This feature is intended to provide general information only, does not constitute legal advice, and cannot be used or substituted for legal or tax advice.