HHS will not allow health insurers to have different rules for individual policies sold for children with medical problems than for healthy kids, according to Kaiser Health News. Instead, they have two options--enroll all children year-round or decline to enroll all children outside the open-enrollment period, the New York Times reports.
Some insurers want to allow healthy children to enroll year-round but only have a limited open season for ones with pre-existing conditions. However, HHS Secretary Kathleen Sebelius said in a letter to the National Association of Insurance Commissioners that such an approach is legally questionable and "inconsistent with the language and intent" of the healthcare law.
But, Sebelius acknowledged, rates can "be adjusted for health status as permitted by state law" until 2014, when the federal law prohibits such variation, Kaiser reports. As such, insurers could charge higher premiums to sick children outside the open-enrollment period, if state laws allowed such underwriting, as many do, according to the Times.
In its policy statement, the administration said, "States may set one or more open-enrollment periods for coverage for children under age 19, but cannot allow insurers to selectively deny enrollment for children with a pre-existing condition while accepting enrollment from other children outside of the open-enrollment period."
HHS is considering creating a national open enrollment period, noted Office of Consumer Information and Insurance Oversight Director Jay Angoff. "We could do that, but we need to do it by regulation. And the regulation would take some time," he told The Hill. "But that's something we're very seriously considering and talking to the industry about and if that would result in [companies restarting their coverage] I think that's something that would make a lot of sense."
Insurers reacted to the letter, Kaiser reports, claiming HHS "has created a powerful incentive for parents to defer purchasing coverage until after their children need it--which could significantly raise costs and cause disruptions for families whose children are currently covered by child-only policies," said Robert Zirkelbach, AHIP’s spokesman.
Some major insurers remain on the sidelines--and say they'll stay there until HHS changes its position. "We will no longer offer new child-only policies to help keep costs affordable for those covered by our individual and family plans--plans not offered by an employer," Cigna spokeswoman Gwyn Dilday told the Orlando Sentinel. "Existing child-only policies remain in effect. We'll continue to evaluate this policy and could reconsider changing this position as market dynamics change."
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