One provision of the new Federal health insurance reform law (PPACA) that became effective on September 23, 2010 was the requirement that all health insurance companies approve children under age 19 without regard for health status. While the new law requires insurance companies to sell coverage there is no requirement for parents to buy health insurance for their children. Fearing “adverse selection” where people would wait until they got to the hospital to sign up for coverage then cancel it after they received treatment (like buying fire insurance when your house is on fire) virtually all of the insurance companies refused to sell children only health insurance.
In response, Governor Schwarzenegger signed AB 2244 into law September 20, 2010. This new law requires all California health insurance companies to offer children only individual policies on a “guarantee issue’ (GI) basis beginning January 1, 2011. Failure to comply will cause the California health insurance company to be banned from selling individual health insurance plans for 5 years. This penalty is so sever that it forces insurance companies to either accept all children under these conditions, or go out of business.
AB 2244 creates a 60 day “initial open enrollment” period during which all children will be able to enroll in an individual health insurance plan without regard to pre-existing medical conditions. After this period, all children under age 19 will have an opportunity to enroll in an individual health insurance plan on a GI basis during the month of their birth.
Also, the responsible parent/guardian of a child will be able to enroll a child on a GI basis on a “late enrollment” basis within 63 days of one of the following situations:
“(1) The child lost dependent coverage due to termination or change
in employment status of the child or the person through whom the
child was covered; cessation of an employer’s contribution toward an
employee or dependent’s coverage; death of the person through whom
the child was covered as a dependent; legal separation; divorce; loss
of coverage under the Healthy Families Program, the Access for
Infants and Mothers Program, or the Medi-Cal program; or adoption of
the child.
(2) The child became a resident of California during a month that
was not the child’s birth month.
(3) The child is born as a resident of California and did not enroll in the month of birth.
(4) The child is mandated to be covered pursuant to a valid state
or federal court order.”
Further,
“(1) During any open enrollment period or for late enrollees, the
rate for any child due to health status shall not be more than two
times the standard risk rate for a child.
(2) The rate for a child shall be subject to a 20-percent
surcharge above the highest allowable rate on a child applying for
coverage who is not a late enrollee and who failed to maintain
coverage with any health care service plan or health insurer for the
90-day period prior to the date of the child’s application. The
surcharge shall apply for the 12-month period following the effective
date of the child’s coverage.
(3) If expressly permitted under PPACA and any rules, regulations,
or guidance issued pursuant to that act, a health care service plan
may rate a child based on health status during any period other than
an open enrollment period if the child is not a late enrollee.
(4) If expressly permitted under PPACA and any rules, regulations,
or guidance issued pursuant to that act, a health care service plan
may condition an offer or acceptance of coverage on any preexisting
condition or other health status-related factor for a period other
than an open enrollment period and for a child who is not a late
enrollee.”
