Kids Health Insurance: What Moms Need to Know Now

For parents of sick children, healthcare reform brought welcome news: No child under age 19 can be denied health insurance due to pre-existing conditions.
But you still have to buy a policy.
For many families, this can be a challenge, especially with high unemployment and the erosion of employer-sponsored health plans resulting in many children being uninsured.
Fortunately, in 16 states, you can purchase child-only policies. But you can’t get your child an insurance policy whenever you get around to it. You must get health insurance during specific open-enrollment periods and most parents do not know this. Each state’s open enrollment period is different and is based on various factors.
To help illustrate the state-by-state open enrollment timing and other information for child-only policies, a release and chart from eHealthInsurance.com is included. FAQs from eHealthInsurance are also included to help moms maneuver through the child-only policies.
Health Insurance for Children: eHealthInsurance Publishes State Summary, Answers Questions
Mountain View, CA – January 18, 2011 – Today eHealthInsurance (NASDAQ: EHTH), the leading online source of health insurance for individuals, families and small businesses, released a summary review of enrollment periods for child-only individual health insurance plans in select states and answers to frequently asked questions (FAQs) about child-only coverage.
“Child-only” plans are those made available to children age 18 and under with no parent or guardian listed on the same policy. Federal health reform legislation prevents insurers from declining health insurance applications for children due to pre-existing medical conditions. However, the implementation of the law differs from state to state.
In some states, insurers offering individual health coverage to adults are required to also offer individual health coverage to children. Separately, certain states have created “open enrollment” periods for child-only plans – specific annual or biannual enrollment windows when applicants can enroll children in individual health insurance plans without danger of being declined due to their medical history.
The state-by-state summary information and FAQs below represent a snapshot of current rules and processes governing child-only health insurance in select states. This document is not a comprehensive review of every state’s plan for compliance with the federal health reform law, and the information relating to child only plans may change. For continuing coverage of child-only coverage in different states, please visit the eHealthInsurance consumer blog, Get Smart – Get Covered.
States offering specific open enrollment periods for child-only individual health insurance¹

* Note that additional qualifying events may allow for enrollment outside of these periods.
Child-only Health Insurance Coverage: Frequently Asked Questions (courtesy of eHealthInsurance.com)
Rules and regulations may differ from one state to another. For more information, see the Additional Resources section at the end of this release and contact your state’s Department of Insurance.
Question: “In my state there are only specific times when I can enroll my child in a child-only health insurance plan. Why aren’t children allowed to enroll in individual health insurance any time of year?”
Answer: Many states have established annual enrollment periods for child-only health insurance policies to prevent parents with uninsured children from simply waiting until a child gets sick to sign them up for coverage. If children were only enrolled when ill, it could potentially cause a spike in the cost of coverage. It could also discourage some insurers from offering these types of plans. By creating specific enrollment periods for child-only health plans, individual states may aim to promote broader consumer access to individual health insurance for children, or to keep prices in check.
Question: “When can I sign up my child for coverage under a child-only individual health insurance plan?”
Answer: The answer is going to vary depending on your state. See the chart above. Some states have instituted annual or biannual enrollment periods. Others have instituted floating enrollment periods that may depend on your child’s date of birth.
Question: “Are these special enrollment periods the ONLY time when I can sign up a child for coverage under a child-only individual plan?”
Answer: Most health insurance companies allow for enrollment of children in child-only plans outside the special enrollment periods under certain circumstances. Special enrollment opportunities may be triggered throughout the year when a “qualifying event” occurs. Qualifying events may differ from state to state (contact your state Department of Insurance to learn more), but could include:
* Birth
* Adoption
* Marriage of a parent
* Divorce of a parent
* Loss of employer-sponsored health insurance
* Loss of eligibility for Medicaid or a state-sponsored child plan
* Valid court order mandating the child be covered
Question: “Can I still enroll my child in an employer-sponsored group plan or individually purchased family plan at other times of year?”
Answer: Yes. Special enrollment periods for child-only health plans do not affect your child’s eligibility for coverage under employer-based health insurance plans or under privately-purchased plans when a parent or guardian is covered under the same policy.
Question: “Are rates for child-only health insurance policies going to change?”
Answer: It is not yet clear how this specific provision of the health reform law will affect the overall cost of health insurance for children.
Question: “Does this mean that a child with pre-existing medical conditions will pay the same as a healthy child if enrolled during the open enrollment period?”
Answer: Not necessarily. While insurers offering child-only plans may not decline applications for persons with pre-existing medical conditions during a specified open enrollment period, insurers in some states may have the option to charge high-risk children monthly premiums higher than those they charge for healthier children.
Question: “What counts as a pre-existing medical condition?”
Answer: A pre-existing medical condition may be any past or present medical diagnosis, whether or not the child is still suffering from or being treated for the condition. Not all medical conditions are of concern to health insurance carriers and different carriers may be more – or less – concerned by different conditions.
Question: “What if there are no child-only health insurance plans available in my state?”
Answer: While some states have required insurers offering individual health insurance policies to adults or families to also offer individual policies to children only, others have not. To find out which insurance companies – if any – are offering child-only health insurance plans in your state, contact your state Department of Insurance. Some insurers offer child-only plans for sale to consumers directly, while others may also make them available through licensed agents.
If there are no child-only coverage options in your area, you may still be able to apply for a privately purchased family plan covering yourself and your child together. Be sure, however, not to cancel your current health insurance plan before you’re approved for a new one.
If purchasing family coverage is not an option and you are unable to add your child to an employer-sponsored group plan, contact the non-profit Foundation for Health Coverage Education (www.coverageforall.org) to learn more about government-sponsored options.
Additional Resources:
* Visit the eHealthInsurance consumer blog Get Smart – Get Covered for updates on child-only health coverage in your state
* Specific FAQs for California child-only coverage
* Specific FAQs for Colorado child-only coverage
* For more information on the Patient Protection and Affordable Care Act, go to www.healthcare.gov
* For more information specific to your state, contact you state’s Department of Insurance
* The eHealth, Inc. Media Center
Notes:
1 According to published information on state enrollment periods as of January 12, 2011. Please refer to each state’s department of insurance for more information.
Six tips for families shopping for child-only health insurance
For families looking to find a “child-only” plan, if their child is healthy or has a pre-existing medical condition, the non-group private insurance market can now provide important benefits at affordable prices. To help parents and guardians who may be shopping for their children for the first-time, eHealthInsurance has provided the following six tips for parents to utilize.
1. Get hip to health reform: The non-group, “individual” health insurance market has undergone some significant changes between 2010 and 2011. Many of these changes benefit you if you’re shopping in the non-group insurance market for your child.
The new reforms include free coverage for specific preventive care services and the elimination of lifetime dollar limits on certain health benefits deemed to be essential by the Department of Health and Human Services, including regular well-baby and well-child visits, from birth to age 213.
2. Buy coverage that fits your child’s specific needs: For healthy kids over the age of two, the National Institutes of Health4 recommends annual physical exams (once per year) to check on your child’s health. Under the new health care reform law, preventive care visits are covered with no out-of-pocket costs, which means you will not pay a co-pay or have to meet your deductible before the insurance company pays for the visit3.
However, parents and guardians should be aware that any care prescribed by the physician as a result of the child’s check-up will likely be subject to deductibles and/or co-pays. Non-group individual health insurance typically provides more flexibility than group coverage by offering lower monthly premiums and higher deductibles. This saves you money each month that your child doesn’t receive medical care. But, if your child gets ill, your higher deductible plan will typically cost you more before you reach the plan’s out of pocket maximum and the insurer begins to cover all of your costs.
It may make sense to put a healthy child on a higher deductible plan, but if you have a child that has been previously denied access to the private insurance market due to a pre-existing condition, they may have needs that warrant purchasing a plan with a higher premium and lower out-of-pocket costs.
3. Put physicians before prices (when possible): There are a number of criteria that a parent or guardian should evaluate when they’re considering enrolling a child into a “child only’ health insurance policy. The price of the plan is typically one of those criteria, and often the most important one. But, the network of physicians who accept this plan should not be overlooked.
And, as is the case with most health insurance plans, certain fixed costs like deductibles and co-pays may change when a patient visits a provider that is outside their plan’s preferred provider network. The “Physician Finder” tool at eHealthInsurance.com can quickly point a parent to a physician in their area who accepts the type of coverage they’re considering for their child.
It’s also a good idea to use the tool to find the physician’s phone number so that you can contact their office directly and see if they’re accepting new patients.
4. Comparison shop for plans: The internet makes it incredibly easy to compare health insurance products for your child side-by-side. Be sure to pay attention to monthly premiums, annual deductibles, co-pays, coinsurance rates, and prescription drug costs. Each of these elements may change, depending on the plan you enroll your child in so be certain that you understand what they mean and how they’ll impact the plan you choose.
5. Talk to an expert for free: Take advantage of the assistance provided by a knowledgeable licensed health insurance agent who represents a number of different carriers.
An agent with an unbiased perspective can help you compare coverage options dispassionately and pick the best plan to fit your needs. eHealthInsurance.com is the leading online provider of individual health insurance plans available in the nation, and full-time eHealthInsurance employees who are licensed health insurance agents are available to answer questions 24 hours a day, seven days a week.
6. Mix and Match: Depending on health conditions, it may be less expensive for healthy children or other family members to be on health insurance plans other than an employer-sponsored plan. A November survey by the consulting firm Mercer5 found that one-in-five (20%) small employers plan to drop their group health coverage due to new health care reform legislation5 . In some cases employers have already stopped offering group coverage, or stopped covering the cost of coverage for dependent adults and or children.
These types of changes underscore the importance of having no underwriting for children, and for parents and guardians to examine non-group coverage during their state’s 2011 annual open enrollment period.
Sources
3 Department of Health and Human Services’ Preventive Care and Services Guidelines (http://www.healthcare.gov/law/provisions/preventive/index.htmlDescription: http://news.ehealthinsurance.com/pr/ehi/images/external.png)
4 The National Institutes of Health Recommendations: (http://www.nlm.nih.gov/medlineplus/ency/article/001928.htmDescription: http://news.ehealthinsurance.com/pr/ehi/images/external.png)
5 Mercer Survey: Few employers planning to drop health plans after reform is in place, survey finds (http://www.mercer.com/press-releases/1399495Description: http://news.ehealthinsurance.com/pr/ehi/images/external.png)
About eHealth
eHealth, Inc. (NASDAQ: EHTH) is the parent company of eHealthInsurance, the nation’s leading online source of health insurance for individuals, families and small businesses. Through the company’s website, www.eHealthInsurance.com, consumers can get quotes from leading health insurance carriers, compare plans side by side, and apply for and purchase health insurance. eHealthInsurance offers thousands of individual, family and small business health plans underwritten by more than 180 of the nation’s leading health insurance companies. eHealthInsurance is licensed to sell health insurance in all 50 states and the District of Columbia, making it the ideal model of a successful, high-functioning health insurance exchange. Through the company’s eHealthTechnology solution (www.eHealthTechnology.com), eHealth is also a leading provider of health insurance exchange technology. eHealthTechnology’s exchange platform provides a suite of hosted e-commerce solutions that enable health plan providers, resellers and government entities to market and distribute products online. eHealth, Inc. also provides powerful online and pharmacy-based tools to help seniors navigate Medicare health insurance options, choose the right plan and enroll in select plans online through its wholly-owned subsidiary, PlanPrescriber.com (www.planprescriber.com) and through its Medicare website www.eHealthMedicare.com.
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This is a sponsored post. The information contained in it was provided to me by eHealthInsurance.