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Insurance Rules for Children

According to CoverTheUninsured.org, more than 7 million children in the U.S. do not have health insurance. The passage of the 2010 health reform bill sought to expand health insurance coverage for children by improving access to preventive health care and make it easier to enroll in an insurance plan. While the law targets all Americans by 2014, many of its most prominent features affected health insurance company policies regarding children as early as 2010.

  1. Enrollment Periods

    • Insurers can determine the number and length of open enrollment periods for children unless the state in which they provide coverage mandates minimum enrollment standards. However, if an insurer allows adult policyholders to add children as dependents to insurance plans outside of open enrollment, the insurer cannot require that parents with a child with a pre-existing health condition wait until open enrollment to add the child to the health insurance plan.

    Denials

    • The Affordable Care Act prohibits discrimination of children due to the health of a child. As of September 23, 2010, health insurers cannot deny health insurance to a child with a medical condition that began prior to applying for coverage. The rules apply to all children under the age of 19. Insurers are also prohibited from rescinding insurance coverage at any time during the policy due to minor errors in paperwork or the health insurance application process.

    Preventive Care

    • Like adults, children insured by a private health insurer have the right to routine preventive care to prevent the onset of disease and screen for health conditions. For example, if you take your child to the pediatrician for a check-up, at which time he receives an immunization, blood pressure check and hearing screening, your health insurance provider must pay 100 percent of the medical bill associated with the doctor visit without charging you a copay, coinsurance or subjecting the cost of the visit to your annual insurance deductible.

    Extended Dependency

    • In September 2010, part of The Affordable Care Act went into effect to extend childhood dependency for health insurance purposes into adulthood. Under the law, your adult child under the age of 26 may remain on your health insurance policy as a dependent, regardless of whether or not she lives in your household, is financially dependent on you, attends school or is married. Additionally, insurance companies cannot charge higher premiums for adult children than for minor children listed as dependents on your insurance plan.

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