Insurers Can Set Higher Rates for Kids Who Have Pre-Existing Conditions

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On Wednesday, HHS said that health insurers can charge higher premiums to cover children with pre-existing conditions, in an attempt to persuade companies to offer child-only policies, the New York Times reports (Pear, New York Times, 10/13).

Under the federal health reform law, insurers must honor all applications for child-only coverage, which could allow parents to sign up their children only when they become sick. Parents then could halt payments when their children no longer need coverage, which insurance industry officials said would drive up medical costs and make insurers' financial risk unmanageable (California Healthline, 9/21).

As a result, some insurers have decided to stop offering child-only policies.

Jay Angoff -- director of the Office of Consumer Information and Insurance Oversight at HHS -- said that until the overhaul bars such practices in 2014, insurers can adjust their rates based on children's health status, as long as they comply with state law (New York Times, 10/13).

Sebelius Rejects Selective Enrollment

Meanwhile, in a letter to the National Association of Insurance Commissioners on Wednesday, HHS Secretary Kathleen Sebelius said insurers could not address their concerns about child-only policies by enrolling healthy children year-round, while holding a limited "open season" for children with pre-existing conditions.

She said such a practice could be unlawful and is "inconsistent with the language and intent" of the overhaul (Carey, Kaiser Health News, 10/13).

Sebelius also admitted that the federal government cannot force insurers to offer child-only policies. She wrote, "Nothing in the [health reform law], or any other existing federal law, allows us to require insurance companies to offer a particular type of policy at this time."

Angoff Suggests National Enrollment Period

Angoff said HHS is "very seriously considering" creating a national open-enrollment period for child-only policies, which could prompt insurers to reconsider dropping the plans (Pecquet, "Healthwatch," The Hill, 10/13).

However, he suggested that states can move faster to create such systems. He said, "Some states, including California, Colorado, Ohio, Oregon and Washington, have already established open-enrollment periods" (New York Times, 10/13).

Deborah Rangel
Many health insurance companies refuse to cover people with conditions such as heart disease, cancer, asthma, diabetes, and high blood pressure. Some relatively minor conditions, such as hay fever or injury, may also cause people to be excluded from health coverage. While there will be many changes in the next few years, it is important to know how having a medical condition will affect your health insurance today.
Anne Cuenca
Having an open enrollment period is definitely better than mandating providers to cover children only whenever they need coverage or have insurers drop child only policies. Anne C NY Health Insurer

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