Parents who have children with chronic medical problems carry a burden of worry that goes above and beyond that of the usual challenges of parenting. Add to this, the financial questions that arise when there is the necessity to change to a new health insurance. Many health insurances, including group plans provided by employers, don’t cover pre-existing conditions--health problems that exist before you apply for a health plan. This means that children with chronic illnesses, such as asthma, sickle cell disease, diabetes, leukemia, cystic fibrosis, birth defects, developmental disorders, orthopedic problems or other chronic conditions, may not be covered by your new insurance plan.
Pre-Existing Condition Exclusions
Most health care plans accept new patients, but specify limits to coverage for pre-existing medical conditions. The insurance plan may accept your child into the plan, and they certainly accept your monthly premium payments, but they often impose an exclusion period during which they will not cover any services or care for pre-existing conditions. Exclusion periods vary according to the health insurance company policies and state insurance regulations, but generally range from six to 18 months. Depending on the particular plan and the state, exclusions may apply only to conditions for which you received treatment during the six-month period before you enrolled into the new health care plan.
Health Reform Act And Pre-existing Condtions
The Patient Protection and Affordable Care Act, or PPACA, enacted into law in March 2010, and described at The Democrat Policy Committee, requires that insurance plans provide coverage to children through the age of 26. This act also mandates the elimination of pre-existing condition exclusions that most health plans impose. While many provisions of the PPACA won’t take effect until 2014, these provisions regarding children apply in September 2010.
HIPAA And Pre-existing Conditions
The Health Insurance Portability and Accountability Act of 1996, described at Insure, provides some protection when you need to buy, continue or change your health insurance. This law prevents many health plans from denying new or continuing coverage based on health problems in your family. Nonetheless, insurance companies, always interested in their own bottom line, are still able to impose pre-existing condition limits, and are able to deny coverage under certain conditions.
Creditable Coverage
Creditable coverage, described at Minnesota Department of Health, refers to health insurance coverage you had before you enrolled in a new plan. If this coverage was not disrupted by a period of non-coverage of greater than 63 days, then the period of coverage you had with your prior insurance offsets the exclusion period of pre-existing conditions. For example, if your child had a year of health insurance coverage for a condition, this one year of coverage contributes one year of credit toward your child’s exclusion period. If the exclusion period is only one year, then your child would be covered for this pre-existing condition.
Limits of Protections
HIPAA and the PPACA apply to health insurance plans, from employer group insurance programs to PPOs, HMOs and Point of Service plans. However,despite the enactment of HIPAA and the Patient Protection and Affordable Care Act, most insurers still maintain that the laws do not require them to necessarily provide policies to children, and does not require them to necessarily provide coverage for children with pre-existing conditions until the full provisions of the PPACA take effect in 2014.
Insurance companies have had lawyers go over the PPACA with a fine tooth comb, and they believe they have found loopholes in the new law. Attorney William Schiffbauer, who represents employers and insurance companies, describes in The New York Times that insurance companies do not have to sell insurance to people with pre-existing conditions, and if the insurance companies chose to, they can increase premiums to cover the added costs. Many insurers are interpreting the law as not guaranteeing the availability of coverage for all people until the year 2014.
Relief
It is possible that some health insurance companies will, instead of refusing to cover pre-existing conditions, merely refuse to provide coverage to children with potentially costly pre-existing conditions. By January 2014 these companies will be compelled by the PPACA to provide coverage, but in the mean time, some insurers may continue to limit their costs by refusing coverage to children with pre-existing conditions.
The PPACA does not guarantee coverage until 2014, but the health reform law does create a short-term national high-risk insurance pool that should be available before the fall of 2010. Children, U.S. citizens and legal immigrants with pre-existing conditions who have been uninsured for at least six months will be able to enroll in this insurance pool and receive federal subsidies to underwrite some proportion of their premiums. This insurance pool will be available until January2014.
For eligibility requirements, application instructions and more information, go to Pre-existing Condition Insurance Plan.
References
- CS Monitor: Health care reform bill 101: rules for preexisting conditions; PeterGrier; 2010
- Democrat Policy Committee: The Patient Protection and Affordable Care Act: Immediate Benefits
- Insurance Lawyers: Health Insurance Coverage FAQs
- Insure: HIPAA: Your Rights to Health Insurance Portability
- Minnesota Department of Health: Frequently Asked Questions: HIPAA
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