Weldin offers clarification of new health care act provisions

Dover - Delaware State Insurance Commissioner Karen Weldin Stewart on Oct. 7 issued the following statement in an effort to answer questions about provisions of the Patient Protection Affordable Health Care Act.

“In traveling around the state, many Delawareans have expressed concerns and have asked me questions concerning the benefits of the new federal Patient Protection Affordable Care Act,” she said. “I would like to take this opportunity to provide answers to frequently asked questions to help alleviate any confusion Delawareans may have in taking advantage of the provision of the Affordable Care Act concerning children under the age of 19 that took effect on Sept. 23, 2010.

“The provision of the act mandates that individuals under the age of 19 cannot be denied coverage or be subjected to a coverage limitation or exclusion because of a pre-existing health condition. The new law applies to both individual and family coverage.”

Question No. 1: Does the new law apply to children covered by group health plans provided by employers as well as policies purchased on the individual market.

A: Yes. Group health plans offered by employers may no longer impose pre-existing condition exclusions on enrollees younger than 19 years of age. This prohibition becomes effective for plan years beginning on or after Sept. 23. This new law applies to both “grandfathered” plans (group plans in existence on March 23, 2010 that do not significantly change their benefits, cost sharing or other features) as well as “non-grandfathered” plans, as defined by the Patient Protection Act. Individuals under the age of 19 cannot be denied coverage or be subjected to a coverage limitation or exclusion because of a pre-existing health condition. The new law applies to both individual and family coverage purchased on or after Sept. 23.

Question No. 2:  Does the new law apply to children with coverage currently in effect that was purchased in the individual market directly from an insurer before Sept. 23?

A: No. The new law only applies to policies issued or renewed on or after Sept. 23. In addition, to the extent the policy is a “grandfathered” policy as defined by the Patient Protection Act, it will be exempt from the new law even after renewal. A “grandfathered policy” is a policy that existed on or before March 23, 2010 and that does not significantly change its benefits, cost sharing, and other features. People should check with their insurer to determine if the new law will apply to a current policy at renewal. If the policy is not a grandfathered plan, the new law will take effect when the policy renews.

Question No. 3: Is it true insurers have ended sales of child-only individual policies?

A: Yes. This is true throughout the nation. In Delaware, the three insurers that sell coverage in Delaware’s individual market have ended sales of child-only coverage. Officials at the Delaware Department of Insurance are considering several options and Weldin is requiring each of the carriers who have stopped writing these individual children’s health insurance policies to meet with her to explain their actions. Weldin said her office is determined to may make certain no child’s health is in harm’s way.

Question No. 4: What is a child-only policy and does the insurers’ announced end of the sale of coverage to children involve family coverage?

A: No. A “child-only policy” is a policy purchased in the individual market directly from an insurer that covers only a child. The announced ending of offering child-only coverage does not involve family coverage and people purchasing coverage in the individual market can buy a variety of health plans for children through family policies.

Question No. 5: How can children with pre-existing conditions and without coverage get health insurance coverage?

A: Coverage continues to be available to children with pre-existing conditions and without coverage through other programs.

Questions should be directed to the insurance department’s consumer hotline at 800-282-8611, or by visiting http://delawareinsurance.gov/ for information.