“The expansion of child-only health plans in Colorado means parents can obtain health coverage for their children to protect them. Child-only coverage permits families to ensure that the youngest family members are covered and can get necessary preventive care and treatment to avoid serious, and costly, problems if uninsured,” said Commissioner of Insurance Jim Riesberg.
This initial open enrollment period under the legislation runs through August 31, 2011; in subsequent years the open enrollment periods will be in January and July. Coverage is effective after a 30-day waiting period following the end of the open enrollment period.
A child-only health policy means there is no adult on the individual policy. There can be many scenarios for this type of policy: the parents may be insured through an employer-sponsored plan which does not offer dependent coverage; or the family may not be able to afford coverage for all members, and is seeking coverage for the children only. Life events, such as divorce or job loss, may also affect insurance coverage.
Children who lose coverage due to a qualifying event can obtain child-only coverage by applying within 30 days of the event. Qualifying events include birth, adoption, marriage, dissolution of marriage, loss of employer-sponsored coverage, loss of Medicaid or Children’s Basic Health Plan coverage, or entry of a court or administrative order mandating coverage. Outside of a qualifying event, a child-only policy can be applied for only during an open enrollment period.
Carriers writing child-only policies must issue them without regard to the child’s health status or condition, a requirement under federal health care reform.
On May 3, 2011, the Colorado Division of Insurance issued an emergency regulation to implement the new law governing child-only health benefit plans, which can be found at http://www.dora.state.co.us/insurance/regs/eindex.htm. A permanent regulation, Insurance Regulation 4-2-33, will take effect September 1, 2011.
In addition, the Division has compiled a list of Frequently-Asked Questions (FAQ) to help guide consumers and carriers with the new law, which can be found below and on the Division’s “What’s New?” web page: http://www.dora.state.co.us/insurance/what/what.htm.
Frequently Asked Questions
Open Enrollment for Child-Only Health Policies, beginning August 1, 2011
1. What happened? Why can parents now purchase coverage in the individual market for children with pre-existing conditions?
On September 23, 2010, many of the larger consumer protections in the federal Affordable Care Act took effect. Under the new federal health care reform law, insurance carriers in the individual (non-employer) market can no longer deny coverage to a child with a pre-existing condition.
In the 2011 legislative session, the Colorado Legislature passed and the Governor signed Senate Bill 128. The new Colorado law takes an additional step by requiring any insurance company that sells individual policies to adults and families, to also sell child-only policies.
2. Who is selling these types of policies?
Any insurance carrier that participates in the individual market must also sell child-only policies.
3. When will child-only policies be available?
Like many employer plans, there will now be “open enrollment” periods when child-only policies can be purchased. The open enrollment period begins August 1, 2011 and ends August 31, 2011. Beginning January 1, 2012, carriers offering child-only policies must hold an open enrollment period each January and July for the entire month.
4. What if someone misses the August 2011 open enrollment period?
Anyone who misses the August open enrollment period must wait until January 1, 2012 to purchase a child-only policy unless the policy is needed because of a “qualifying event.”
5. What is a “qualifying event?”
A qualifying event is defined in the new Colorado law as birth, adoption, marriage, dissolution of marriage, loss of employer-sponsored coverage, loss of eligibility for Medicaid or Child Health Plan Plus (CHP+), entry of a valid court or administrative order mandating the child have coverage, or involuntary loss of existing coverage other than because of fraud, misrepresentation or failure to pay premium.
