Coverage to age 26: what the dependent rule requires of your plan.
Plans that cover children must make that coverage available until the child turns 26. The rule does not depend on where the young adult lives, whether they are a tax dependent or whether they are a student.
The rule in plain terms.
Coverage Until 26
DOL says plans and issuers that offer dependent coverage of children must offer coverage to enrollees’ adult children until age 26. Employers should confirm that the plan document, the carrier contract and the enrollment system all use the same cutoff, and that employees are told clearly when a dependent’s coverage ends and what options follow. For a quick estimate, use our free dependent coverage cost calculator.
No Other Tests
The adult child does not have to live with the parent, be claimed as a tax dependent or be a student. This means employers should avoid adding screening questions about residency, student status or support to enrollment forms for these children. Ask the carrier to confirm its forms and rules match the plan.
Applies Even To Grandfathered Plans
DOL lists dependent coverage to age 26 among the requirements that apply to grandfathered plans too. Employers with older plans should still confirm the plan document reflects the rule, and ask the carrier to verify that the dependent definition has been updated and applied consistently to all enrollees.
Only If The Plan Covers Children
The rule applies where a plan offers dependent coverage for children. It does not require a plan to offer dependent coverage at all. If the plan does not offer dependent coverage for children, the rule does not require adding it, but the employer’s decision should be documented and communicated clearly. Counsel can help confirm how it applies.
What the age 26 rule requires.
The General Rule
A plan that offers dependent coverage for children must make it available until the child reaches 26. Coverage ends the day before the 26th birthday. Employers should check that eligibility, premiums and the enrollment portal all treat the oldest eligible dependents the same way as younger children, and that notices reach employees before open enrollment.
Relationship Only
For children under 26, a plan cannot define dependent by anything other than the relationship to the participant. That means the plan’s definition should focus on the parent and child relationship, and not add extra conditions for a child under 26. Review the plan wording and ask the carrier to confirm it.
Conditions That Cannot Be Used
Plans cannot restrict coverage because of financial dependency, residency, student status, employment, marital status, or eligibility for other coverage, alone or in combination. Review plan documents and enrollment forms for any language that adds a requirement of this kind, and remove it where it affects a child under 26. Counsel can advise if the wording is unclear.
Other Relatives Are Different
For relatives who are not children, such as grandchildren or nieces, a plan may add conditions, such as requiring that the person is a tax dependent. Because the rules for other relatives are set by the plan’s terms, employers should state the plan’s definition clearly and ask the carrier and counsel to confirm how it applies to specific family situations.
No Grandchild Coverage Required
A plan does not have to cover the child of a child who is receiving dependent coverage. Employers should explain this in the enrollment materials, so employees understand the difference between covering their own child and covering that child’s child. The carrier can confirm how the plan treats each situation.
Terms Cannot Vary By Age
Cost and benefit terms for dependent children cannot vary by age, except for children 26 or older. An age based premium surcharge for children over 18 would violate the rule, while pricing tiers based on the number of covered people would not.
Source: 29 CFR 2590.715-2714.
Making sure your plan complies.
Check The Plan Definition
Look at how the plan and carrier contract define an eligible child, and make sure the age cutoff is not earlier than 26. Read the contract, the certificate and the plan document side by side, and note any place where the wording differs. Ask the carrier to correct inconsistencies in writing before the next enrollment period.
Remove Extra Conditions
Eligibility conditions such as residency, student status or tax dependency should not be applied to children under 26. If an older enrollment form or handbook still includes those conditions for children under 26, update it and tell the carrier. Counsel can confirm the wording before the revised materials go out.
Align The Calendar
Confirm whether coverage ends at 26 or at the end of the month or year, and make sure materials say so. The termination date matters for payroll deductions, COBRA notices and carrier files, so confirm the same date is used everywhere and communicate it to employees ahead of time to avoid surprises.
Handle Enrollment
Adult children who lost eligibility under an earlier plan design may have special enrollment rights. Ask us about the facts. Ask the carrier and counsel how to handle employees whose children are coming back into eligibility, and give a clear notice with the dates and steps so no one misses the chance to enroll.
Three questions to settle.
What Does Our Carrier Contract Say
The contract and the plan document should match. If the two documents differ, ask the carrier to explain which controls and to correct the difference in writing. Keeping a dated copy of both makes future reviews and audits much easier.
Do We Offer Other Benefits To Dependents
Dental, vision and other plans may follow different rules. Check each. Dental, vision and other ancillary plans may use different age limits or definitions, so ask each carrier how the plan treats adult children and make the rules clear in the enrollment guide.
How Do We Verify Eligibility
Audits of dependent eligibility are a separate topic from the age rule. A separate verification process, for example collecting documents when a dependent is added, helps keep the plan accurate without adding conditions that the age rule does not allow. Counsel can review the approach.
Common Questions About Coverage To Age 26
Does the child have to be a student?
No. DOL says the adult child does not need to be a student, live with the parent or be a tax dependent.
Does it apply to our dental and vision plans?
The rule appears in the health benefits guide for group health plans. Standalone dental and vision are often treated differently, so ask us about yours. Enter a date of birth in our age 26 dependent coverage calculator to see the end date under your plan rule. To estimate what an eligibility audit could save, try our dependent audit calculator.
Does the plan have to cover the child’s spouse or children?
The rule addresses the enrollee’s children. It does not require coverage for a child’s spouse or children.
What if our plan stops at 19 or 23?
That would not meet the requirement for a plan that offers dependent coverage for children. Raise it with your carrier now.
Is it the same as the tax rule for dependents?
No. Tax treatment of the coverage is a separate question. Involve your tax advisor.
Is this legal advice?
No. For your own plan, involve your counsel. We can help you check your documents.
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Laws and rules referenced
42 U.S.C. § 300gg-14 and 29 C.F.R. § 2590.715-2714 — Dependent children must be offered coverage until age 26.
This page is general information, not legal or tax advice. Rules change and facts matter, so confirm your situation with counsel or a qualified advisor.
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