INSURANCE FOR CHILDREN

After October 2010, parents with uninsured children under the age of 19 found themselves faced with a dilemma: if the child could not be put on the parents’ policy (individual or group), the child could not get a major medical insurance on their own. As part of Healthcare Reform, one of the first things that came down the pike was that carriers could no longer deny a child due to preexisting conditions. The carriers didn’t have to cover the preexisting condition immediately (there might be a one year waiting period if the child was not coming from other creditable coverage), and they could increase the premium for the child due to severe preexisting conditions (up to 400%, which is at the discretion of the carrier - some only go 80% regardless of medical history) – but they could not deny them a policy.

So the carriers collectively indicated that they would be happy to comply so long as there was at least one parent on the policy with the child. To take a child alone while the parents were covered elsewhere can become what is called “adverse selection,” depending on why the child is not on the parents’ policy to start with. A child’s on-going medical conditions can have a very definite negative impact on an employer’s group plan. Many people do not want to put a child on their group plan as it can add as much as $300-$600 per month to their premium. Anyone on an individual plan can currently add a child under the age of 19 to the plan – the rate, depending on the health of the child, could be anywhere from the standard dependent rate to four times that.

At Arizona Life Lines, we offer five different short term plans designed for children under the age of 19. These are temporary plans good for up to 11 months at a time: four plans go six months and a few can be re-applied for indefinitely; one goes 11 and cannot be re-applied for. We don’t use the word ‘renew’ because that would imply continuous coverage and on these plans, anything a child is treated for in the first period of coverage, is not going to be covered in the next period of coverage - it is now preexisting. Therefore, plans are not considered ‘renewable’ but can be reapplied for so long as the health questions that are asked, cannot be answered YES. Among the more common questions asked are cancer, heart disorder, diabetes, kidney and liver disorders, severe respiratory disorders (emphysema, COPD), blood disorders and drug or alcohol abuse. There are a few other questions, depending on the carrier, but these specific questions are asked on almost all applications.

Deductibles start as low as $250 and go up to $2500; coinsurance varies. These plans cover no preexisting conditions; they are true insurance: covering you for anything new in the way of illness or injury. They do not offer office visit co-pays, everything comes under the deductible. But they are million-dollar policies and are good anywhere in the United States.

Children can also qualify for the PCI Plan: Preexisting Condition Insurance Plan. This is through the federal government, so long as they have been without creditable coverage (and not on AHCCCS) for the last six months. Under the age of 19 these plans run $174 per month and have a $2500 deductible. The website to look at this plan is www.pciplan.com.

If we can help you with any temporary plans for your children – or yourself – call us at 623-435-5511 or – outside Maricopa county – 888-543-5637. These plans can be put into effect within 48 hours of receipt of e-mailed, mailed or faxed application.