HHS permits insurers to establish open enrollment periods for child coverage

Responding to concerns that the new health care law’s prohibition on denying coverage to children with pre-existing conditions would significantly drive up costs, the U.S. Department of Health and Human Services (HHS) has clarified that plans may set up specific enrollment periods. Insurers had predicted that the non-discrimination coverage requirement that takes effect for most plans beginning on or after September 23 would result in parents enrolling their children only once they became sick.

Amid reports that many insurance companies were considering dropping child coverage altogether, the HHS on July 27 issued a fact sheet explaining, in question and answer format, how the prohibition on pre-existing condition exclusions applies to insurers offering coverage to children under 19 years old in the individual market. Specifically, the HHS clarified that:

Insurance issuers in the individual market may restrict enrollment of children under 19 to specific open enrollment periods – the number and length of such periods to be at the insurer’s discretion – if permitted under state law. Insurance issuers must abide by more stringent state laws, if applicable, that require issuers to maintain a continuous open enrollment period or regulate the number and/or frequency of these enrollment periods.

Child-only individual market insurance plans that existed on or prior to March 23, 2010, and that do not significantly change their benefits, cost sharing, and other features, will be “grandfathered” and thus exempt from the regulations prohibiting pre-existing condition exclusions.

The administration will issue new regulations if it determines that insurers are using their enrollment periods to limit coverage access, or if children with pre-existing conditions are being diverted inappropriately from Medicaid or the Children’s Health Insurance Programs (CHIP) to private insurance plans.

New Health Bill Permits Children to Remain on Parents’ Insurance

At a rally on Friday at George Mason University in Fairfax, Va., President Obama got some of his loudest applause when he talked about a provision in the health care legislation that would allow adult children to remain on their parents’ health insurance policies until the age of 26.

The provision cited by the president is of the more significant changes included in the reconciliation bill in terms of what the legislation will mean in the short term for consumers of private health insurance.

The Senate-passed bill would have required insurers to offer dependent coverage for adult children, but only in new insurance policies. Existing policies would not have had to include the change.

Currently, states determine the age at which dependent children no longer must be covered by their parents’ plans, and the limits vary.

The reconciliation bill, which is to be voted on by the House on Sunday, would allow parents to keep their adult children on their insurance plans and would require all insurers to make such coverage available through existing policies. Of course, insurers could still charge for it, and the coverage might not be cheap.


The change would take effect six months after adoption of the legislation. The reconciliation bill says that the dependent coverage must be made available only if the adult child has no option to enroll in group health insurance coverage through an employer.

The provision is among the most popular aspects of the legislation because of its potential benefit to Americans who already have health insurance through the employers, which is to say a majority of the population.

Speaker Nancy Pelosi has also stressed the inclusion of that provision in the bill, noting at rallies and news conferences in recent days that college graduates would be free to pursue their dreams without worrying whether they could immediately obtain health insurance on their own.

A parent's worst nightmare: sick child, no insurance

Every parent knows it. The late-night sound of a child coughing uncontrollably. A flushed face that can only mean fever. A normally active child rendered listless by illness. For most, the worry is wrenching, but the routine is simple if urgent -- scoop up the child for an immediate trip to the family pediatrician's office, present an insurance card, fill out forms and perhaps fork over a co-pay.

But for some -- a growing number in Santa Cruz County, and elsewhere in this economy -- insurance for their children is something they just cannot afford. And for doctors treating children, they see an increasing panic among parents who cannot provide for their kids, who must take risks and shortcuts with their children's health.

Here are the stories of parents and families, of children and doctors. Here are the voices of mothers like Andrea Eaton, who has spent countless panicked hours navigating a bureaucratic labyrinth because she makes a few dollars too many to qualify two of her children for a state-funded insurance program.

Donna Gilmartin knew that panic, too. She'd just moved to town with Bryce, her then-10-week-old son. She could work only part-time, so she had no health insurance. Each day, she felt increasingly vulnerable. When her boss mentioned Healthy Kids, she quickly investigated and enrolled. The program was a boon to Bryce and a salve to Gilmartin's psyche. Healthy Kids came through for 1-year-old Tawny, too. When Dina Larsen, Tawny's mother, lost her job and her insurance, she said she experienced 10 of the most frightening days of her life. It was Healthy Kids that got life in balance again.

Then, there are the doctors, devoted pediatricians like Madhu Raghavan and Christine Griger, with a half-century of Santa Cruz pediatric care between them. They say they see an increasing number of kids like Bryce and Tawny -- but many of the ones they treat are children whose parents haven't been able to solve the insurance problem. They have no insurance.

And these physicians see something else. All too often, parents who can't afford to bring their children in try to care for their medical needs through long phone calls with doctors. When these uninsured kids show up, it's only when their condition is too bad to ignore. A once easy-to-care-for illness has become something serious.

These are the parents and the doctors who provide care for their children. These are the voices of the still unresolved children's insurance problem.

Richard Kipling works for the California HealthCare Foundation Center for Health Reporting.