Child-only health insurance is a health plan for a child, or children, without an adult on the same policy. Health insurance rates for infants under 1 year old are higher and this is understandable, because all health insurance plans now include well-child baby visits and routine exams that include blood tests and other diagnostic tests. Once beyond the toddler stage, children’s health insurance is affordable. That’s because children in the elementary school age group are less likely to develop serious illnesses. Heath insurance plans that include good coverage for emergency room visits is important at this age, becuase K-8 school age kids are more susceptible to accidents. Teenagers are even more accident prone what with driving and contact sports. For health insurance purposes, they are considered children until age 19.
The Affordable Care Act (ACA) legislated that no exclusions of coverage would be allowed for children through age 18. This provision of the law was one of the first to be implemented and became effective in 2010. The intent of the law was to make health insurance for children guaranteed-issue - meaning the child be turned down because of pre-existing conditions. Currently, health insurance carriers in 28 states offer child only coverage on a guaranteed issue basis. In some states child-only coverage is available all year long. In others, child only coverage is available only once or twice a year during open enrollment periods. In the other 22 states, insurers refuse to comply with the law’s intent because guaranteed-issue for children without a mandate for all children to be insured would be too costly. Quite possibly, this stalemate will continue until January 2014, when all health insurance is guaranteed-issue.
The California Guidelines
Health insurance carriers in California have complied with the ACA’s intent for guaranteed-issue child-only coverage by imposing open-enrollment periods in lieu of a mandate.
- Annual Open Enrollment Period during the month of the child’s birth date.
- Late Enrollment Period, within 63 days of any of the following conditions:
- Loss of group health coverage because of termination or change in employment,
- Loss of employer contribution,
- Death of primary insured,
- Legal separation or divorce of primary insured causes loss of coverage,
- Loss of Healthy Families, AIM, or Medi-Cal coverage.
- Recently became a resident of California,
- Newborn in California but did not enroll in birth month,
- Coverage of child mandated by court order,
- Child is newly adopted.
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