Health insurance plans will be able to use limited sign-up periods and still comply with a health reform provision that eliminates pre-existing condition exclusions for children under age 19, HHS announced.
HHS clarifies stance on pre-existing conditions
Interim final regulations released in June by HHS prohibits new group health plans and health insurance issuers in both the group and individual markets from imposing pre-existing condition exclusions on children under 19 for the first plan year, beginning on or after Sept. 23. The department sought to clarify in a question-and-answer document the procedures under which children under 19 years of age could be guaranteed coverage, despite any medical problems.
“To address concerns over adverse selection,” plans in the individual market may restrict enrollment of children under 19, whether in family or individual coverage, to specific open enrollment periods if allowed under state law, according to the HHS. As an example, insurers could limit the sign-up to an open enrollment period from Dec. 1 to Dec. 31 for plans that start Jan. 1.
Karen Ignagni, president and CEO of America's Health Insurance Plans, supported the department's decision.
“Today's announcement will help ensure millions of children have access to affordable healthcare coverage,” she said in a written statement. “For years, structured enrollment periods have been used in the Federal Employees Health Benefits Program, Medicare, and in employer based coverage to minimize disruption for families, seniors, and small businesses. Health plans are committed to working with federal and state officials to ensure consumers are aware of all of their coverage options, including how and when they are able to sign up for coverage.”
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