Since the health care reform law was enacted in March 2010, some changes have taken place in the health coverage industry. One major provision involved kids' health insurance plans and how they handled pre-existing conditions. In the past, insurance companies could refuse to cover kids with pre-existing medical conditions. Nowadays, insurance companies must cover all kids, regardless of health status.
More than half a million kids in California alone are estimated to be affected by this change in policy, and millions more may be affected across the country. Their parents can now obtain insurance plans on the open market without risking a denial or unreasonable premium increases if their child has been diagnosed with a pre-existing medical condition. While insurance providers cannot deny coverage for children with pre-existing conditions, they can charge more. Still, they still may not charge more than twice the standard rate.
When obtaining a child health coverage plan, you will need to sign up during the appropriate enrollment period. Most insurance providers offer an open enrollment period. You will also generally be able to enroll if you experience a qualifying event, such as the divorce of a parent, job change, death or other major life change. If insurance is obtained outside the open enrollment periods, the price may be higher. Furthermore, if a child has been without health coverage for more than 90 days before enrolling for a new plan, an insurance provider may also impose a 20 percent surcharge. After 12 months, though, this surcharge must be discontinued.
In order to fully assess the cost of a children's health coverage plan, a family should consider not just the cost of the monthly premium but also any associated out-of-pocket expenses, such as the annual deductible, coinsurance, copayments and any other costs. The right plan will fit comfortably into a family's budget without compromising on any necessary benefits. An inexpensive plan may be attractive at first, however if it lacks in crucial benefits, it may not in the long run be worth it. If the policy is a managed care plan, the parents should ensure the child's pediatrician or family care physician is in the plan's network of providers to keep costs more reasonable.
When insuring multiple children, families may have other considerations. For some, it may make more financial sense to insure children separately, especially if one child has a pre-existing medical condition. That way, only one policy will include the higher rates associated with the condition. Yet, other families may realize more savings by opting for a family health plan, which can cover all members of the family. Family health plans will often have individual deductibles as well as a family deductible, which may allow them to benefit more, depending on their overall health care needs.