Medical Insurers Discontinuing Child-Only Plans

In response to the provisions of the Patient Protection and Affordability Care Act, which limits the exclusion of children with pre-existing conditions as of September 23, 2010, many insurers nationwide have decided to suspend all sales of child-only applications. However, many medical insurance companies are accepting children with pre-existing conditions on family plans as long as the primary subscriber on the plan is 19 years or older.

Those insurers that have suspended child-only applications have reviewed the rules that govern the provisions of healthcare reform, and have stated that there’s a huge deal of uncertainty as to how the new rules regarding the limitation of pre-existing condition exclusions for children will be implemented and what kind of impact it will have on them.

Aetna has suspended sales of their individual child-only plans in the following states effective October 1, 2010:

Alaska

Arkansas

Arizona

California

Colorado

Washington DC

Delaware

Florida

Georgia

Illinois

Indiana

Kansas

Kentucky

Louisiana

Michigan

Mississippi

Missouri

North Carolina

Nebraska

Nevada

Pennsylvania

South Carolina

Tennessee

Texas

Virginia

West Virginia

Wyoming

In addition, the following states will suspend their Aetna individual child-only plans on November 1, 2010: Connecticut, Ohio.

Anthem Blue Cross has reviewed the healthcare reform provision regarding limiting the medical insurance application of children under the age of 19 with pre-existing conditions and has decided to suspend all child-only applications as of September 23, 2010.

According to many medical insurance companies, since some medical insurance companies decided early on to suspend child-only insurance policies, it created an uneven competitive environment.

On September 23, 2010, medical insurance plans across America will be subject to new rules and regulations for new plans issued.

The following benefits will apply for health plans issued with an effective date of September 23, 2010 and later:

  • Insurance plans cannot impose lifetime limits on the dollar value of essential benefits.
  • Annual dollar-value limits on benefits are restricted (Does not apply to “grandfathered” individual plans…but there are some individual insurance companies that have removed these limits on “grandfathered” plans).
  • Insurance companies cannot rescind or void a medical insurance plan, except in the case of fraud or intentional misrepresentation.
  • Adults children who are currently on their parents’ policies and are unable to get medical insurance through their jobs can stay on their parents’ policies until the age of 26, regardless of their marital status.
  • Plans may no longer impose pre-existing condition exclusions on children under the age of 19. (Does not apply to “grandfathered” individual plans, but there are some individual insurance companies that have removed these exclusions on “grandfathered” plans).
  • New policies must cover the full cost of preventative care (Does not apply to “grandfathered” individual plans, but there are some individual insurance companies that have adopted this new provision on “grandfathered” plans).

Leave a Reply