Health reform at 6 months: No more exclusions or waiting periods for children with pre-existing health conditions

National health reform turns six months old on Sept. 23, when a variety of new rules and regulations take effect. In this weeklong series, we highlight how benefits will change for consumers in the near term. You can also find videos, news alerts, RSS feeds and other information at our health reform website.

Those of you who are parents know that there are few things worse than having a sick child, especially when their condition requires serious and oftentimes costly medical attention.

The good news for parents is that the Patient Protection and Affordable Care Act will ban the practices of pre-existing condition exclusions and waiting periods for children under the age of 19.

Before national health reform passed, health insurance companies could turn away kids if they had a pre-existing health condition, such as asthma, diabetes or even cancer.

If the insurance company did agree to cover them, they would sometimes impose a 6- to 12-month waiting period before coverage kicked in. In other words, the family would be responsible for paying out-of-pocket for the condition until the waiting period was over.  Waiting periods are intended to prevent people from enrolling in a health plan only when they’re sick, creating a riskier and more costly insurance pool.

Starting with plan years beginning on or after Sept. 23, families will have more options in getting coverage for children with pre-existing conditions. Blue Cross Blue Shield of Michigan and Blue Care Network have longstanding policies of accepting everyone for coverage, including children, regardless of health history. The Blues will remove waiting periods for children on Jan. 1, 2011, unless the start of their plan year falls on a different date.

Other insurers that are not currently required to offer coverage to everyone will now be required to accept children under age 19 regardless of health status for a certain time period each year. The government has yet to clarify when this period will be and how long it will last.

Health care reform puts an end to the widespread insurance practice of denying coverage to patients of any age for pre-existing conditions in 2014. Until then, commercial health insurance companies in Michigan may continue to cherry-pick the younger, healthier patients, while the Blues continue to offer coverage to anyone who needs it, regardless of health status or pre-existing health conditions. 

In the meantime, the Blues will continue to advocate for reforms here in Michigan that would require all Michigan health insurance companies to guarantee access to coverage for everyone.