Once President Obama signed into law the health care reform bill, we all started to dig a little deeper into what the provisions mean for those in the “real world.” One issue that has risen to the top is untangling the new rules governing when insurance companies have to cover sick children. So, let’s break down what the bill does.
Soon children with employer-based insurance no longer can be subject to pre-existing conditions. For example, a child with asthma who is on a parent’s employer plan cannot be denied coverage for services during any length of time related to his/her condition. This provision will be applicable in a new health plan year beginning after September 23rd. (Note: this specific change will not apply to children currently in individual market plans.)
The question many are asking is “what about a child that is not currently insured?” While the current legislative language is not clear on this issue, the White House has provided assurances that HHS will issue regulations to address it. HHS spokesman Nick Papas stated:
“… the secretary of HHS is preparing to issue regulations next month making it clear that the term ‘pre-existing exclusion’ applies to both a child’s access to a plan and his or her benefits once he or she is in the plan for all plans newly sold in this country six months from today.”
With this clarification, a new health plan would not be able to deny coverage for a child under either an employer or individual plan because of a pre-existing condition. For families with limited or no options to secure coverage right now when their child is sick, this change cannot come soon enough.
While this is all good news for families, how the insurance industry responds to these new protections for children will also be critical. Specifically, since the provision to limit insurers from charging different premiums based on health status doesn’t go into effect until 2014, we need to monitor whether insurers will attempt to place the burden on families and raise premiums once these changes go into effect.
