SOURCE: www.hhs.gov
HHS and states act to expand options for children; new agreements in Maryland likely to result in expanded options for children
In a letter to the National Association of Insurance Commissioners, Secretary Sebelius today outlined efforts by the U.S. Department of Health and Human Services, working with states, to ensure companies keep their promise to “make pre-existing conditions exclusions a thing of the past” for children. The letter comes after insurance companies reneged on their commitment to provide coverage options for children with pre-existing conditions and refused to sell child only insurance policies. The efforts by the Department of Health and Human Services are designed to increase options for children across America and are already having an impact. Today, the state of Maryland will announce a new agreement with Kaiser Permanente of the Mid-Atlantic and Carefirst Bluecross BlueShield that will ensure the two companies continue to sell child-only insurance policies.
The Affordable Care Act makes it illegal for insurance companies to deny coverage to children with a pre-existing conditions and makes discrimination against all individuals with pre-existing conditions illegal in 2014 – a trend that was rising at exceedingly high rates in recent years. In fact,a recent report from the House Energy and Commerce Committee found that more than 651,000 people were denied coverage because of a pre-existing medical condition between 2007 and 2009.
In her letter, Secretary Sebelius further clarified the HHS regulation that implements a key early provision of the Affordable Care Act, signed into law on March 23, 2010 to prevent insurers from denying coverage to children based on a pre-existing condition. This clarification outlines options available to insurers and states to offer child-only policies, but rejects the insurers’ idea of denying coverage to sick children outside the open enrollment period.
“The Affordable Care Act was designed to ensure that Americans who need health insurance are no longer denied access to the care they need – and that includes the youngest and most vulnerable Americans,” said Sebelius. “We have been working closely with the states in their role as insurance regulators and with insurance companies to find ways to improve access to coverage for America’s families.”
Today, the Maryland Insurance Administration will announce an agreement with Kaiser Permanente of the Mid-Atlantic and CareFirst BlueCross BlueShield for those companies to issue policies in the child-only insurance market, a new offering for Kaiser Permanente of the Mid-Atlantic. This agreement, subject to approval by Maryland’s General Assembly, followed a decision by Acting Maryland Insurance Commissioner Beth Sammis to establish uniform open enrollment periods in the State for policies covering children under 19.
“Working with Maryland’s General Assembly, we will establish by regulation an open enrollment period to be sure Maryland families have more options in purchasing insurance for their children, and I commend Kaiser Permanente of the Mid-Atlantic and CareFirst BlueCross BlueShield for their decision to continue to offer this coverage once the regulations are enacted,” said Commissioner Sammis. ” We are committed to working to ensure children can get the health car they need, and are glad we have been able to find a solution where these insurers will sell new policies.”
In her letter to the NAIC, Secretary Sebelius outlined a range of of steps that can be taken to help preserve coverage options for children, regardless of their health status. This includes either states or insurance companies themselves creating open enrollment periods during which parents can purchase coverage for children who are without access to employer-based health plans. Insurers may not enroll only healthy children in coverage outside those open enrollment periods.
Sebelius also encouraged states to take other actions such as seeking appropriate legislation to help preserve options for children with pre-existing conditions. California, for example, recently required individual-market issuers that offer family coverage to also offer child-only policies.
A number states including Maine, Massachusetts, New Jersey, New York, and Vermont already have laws in lace to prevent discrimination against children and others with pre-existing conditions. About a dozen states offer unsubsidized buy-in to the Children’s Health Insurance Program (CHIP) for children so that middle income families can purchase child-only coverage at a full but fair premium. And the new Pre-existing Condition Insurance Plan created by the Affordable Care Act offers additional options for families to access insurance for their children with pre-existing conditions.