Pre-Existing Conditions and Health Insurance Coverage for Children

Health reform has had some positive but also a negative impact on the ability to obtain quality insurance coverage for children.

Under the Affordable Care Act, health plans cannot limit or deny benefits or deny coverage for a child younger than age 19 simply because the child has a “pre-existing condition” — that is, a health problem that developed before the child applied to join the plan.

The result of this requirement did improve coverage for children on family plans.  However, the unintended consequence is that it is now nearly impossible to obtain traditional, “stand-alone major medical” coverage for these children, even if they are healthy. Carriers have had to discontinue stand-alone health insurance products for financial reasons.

Therefore my best advice for parents and guardians is to always consider your dependents in your selection process for a health plan and apply with them.

Some other options:

• Your child may qualify for Peachcare but only if you meet low income
  tests. 

• If the Child has been uninsured for six months he/she may qualify for the Pre-Existing Condition plan. 

• There are guaranteed issue “indemnity plans” that can be obtained which provide a defined schedule of benefits. Examine these carefully comparing premiums, benefits, and any elimination periods for pre-existing conditions. They can be a good choice when all else fails. Some are solid programs while others provide poor benefits. Be diligent in your evaluation.