Currently, a child under age 19 can obtain private health insurance through Kaiser Permanente by applying in one of two ways:
• Under a family application with at least one parent, or a legal guardian.
• On a single subscriber basis if there is a qualifying event.
During the month of August 2011, Kaiser Permanente will accept child-only applications even if there is no qualifying event. During this open enrollment period, child-only forms received in August will be approved for an October 1st effective date. If you are interested in enrolling your minor during the open enrollment, be sure to submit the application in August as it will be rejected if it is received before or after August, unless there is a qualifying event.
What is a qualifying event?
A qualifying event refers to an incident that either required the child to acquire health insurance for the first time, as in the case of a new birth or adoption, or a situation that resulted in the minor losing his or her medical coverage. An example of the latter would be a kid losing his or her medical coverage through an employer-sponsored plan because the business stopped offering group insurance. Below is a list of the qualifying events that will allow kids to apply on a single subscriber basis outside of the open enrollment period:
• Loss of group insurance
• Becoming ineligible for coverage under the Colorado Medical Assistance Act or the Children’ Basic Health Plan
• Court order
• Loss of insurance due to any cause except fraud, misrepresentation, or non-payment of premium.
A paper application plus documentation evidencing the qualifying event are required within 30 days of the incident in order to qualify. Again, the qualifying event restrictions affect kids only when they are not applying on a family plan or at open enrollment.
What if my child has a pre-existing condition?
A child cannot be denied coverage due to medical reasons. However, his or her premium could be rated up if there is a pre-existing condition. The amount of the increase will depend on the severity of the health condition and if the minor was enrolled as a single subscriber or on a family plan. If your child’s application is rated up, you will be notified and be given an opportunity to decline coverage.
How will Senate Bill 128 affect my child’s eligibility and premium?
Currently, only two carriers in Colorado accept child-only applications during open enrollment: Kaiser Permanente and Rocky Mountain Health Insurance. SB128 requires all individual health insurance companies to offer at least one child-only plan at open enrollment.
The bill also gives carriers the option of applying a surcharge on child-only policies for kids who enrolled at open enrollment, then dropped the insurance, only to re-enroll at the next open enrollment. If there was a lapse of coverage for at least 63 days, companies may apply a 50 percent surcharge. This would be in addition to the potential rate-up for pre-existing conditions. As of this writing, the general consensus is that most companies are not anticipated to adopt this aspect of the bill. Carriers that do implement the surcharge feature could apply the increase starting with applications received during the August 2011 open enrollment period.