Can the insurer decline coverage for eligible dependents due to health conditions?
No policy may decline coverage to an eligible dependent due to age (as defined in P.A. 095-0958), health status, or enrollment in an educational institution. The law does not otherwise restrict the definition of dependent. However, the Division will take appropriate enforcement action if the Division finds that an insurer imposed any eligibility requirement as a proxy for age (e.g., restricting coverage based on IRS dependency rules). During the annual enrollment period, the insurer may decline coverage if the dependent does not meet the requirement of 90 days of continuous coverage without a break in coverage of more than 63 days. If the dependent meets these requirements, preexisting condition limitations may not be imposed.
