632.885 Coverage of dependents. - Wisconsin Statutes

632.885

632.885 Coverage of dependents.

632.885(1)

(1) Definitions. In this section:

632.885(1)(a)

(a) "Disability insurance policy" has the meaning given in s. 632.895 (1) (a).

632.885(1)(b)

(b) "Insured" includes an enrollee.

632.885(1)(c)

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

632.885(2)

(2) Requirement to offer dependent coverage.

632.885(2)(a)

(a) Subject to ss. 632.88 and 632.895 (5), every insurer that issues a disability insurance policy, and every self-insured health plan, shall offer and, if so requested by an applicant or an insured, provide coverage for an adult child of the applicant or insured as a dependent of the applicant or insured if the child satisfies all of the following criteria:

632.885(2)(a)1.

1. The child is over 17 but less than 27 years of age.

632.885(2)(a)2.

2. The child is not married.

632.885(2)(a)3.

3. The child is not eligible for coverage under a group health benefit plan, as defined in s. 632.745 (9), that is offered by the child's employer and for which the amount of the child's premium contribution is no greater than the premium amount for his or her coverage as a dependent under this section.

632.885(2)(b)

(b) Notwithstanding par. (a) 1., the coverage requirement under this section applies to an adult child who satisfies all of the following criteria:

632.885(2)(b)1.

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

632.885(2)(b)2.

2. The child satisfies the criteria under par. (a) 2. and 3.

632.885(2)(b)3.

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.

632.885(2)(b)4.

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

632.885(3)

(3) Premium determination. An insurer or self-insured health plan shall determine the premium for coverage of a dependent who is over 18 years of age on the same basis as the premium is determined for coverage of a dependent who is 18 years of age or younger.

632.885(4)

(4) Documentation of criteria satisfaction. An insurer or self-insured health plan may require that an applicant or insured seeking coverage of a dependent child provide written documentation, initially and annually thereafter, that the dependent child satisfies the criteria for coverage under this section.

632.885 - ANNOT.

History: 2009 a. 28.

632.885 - ANNOT.

Cross Reference: See also s. Ins 3.34, Wis. adm. code.