Covered California and ACA related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the ACA and Covered California knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.

Child Denied Coverage

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Question: I applied for my 5 year old son for the Blue Cross Tonik plan and they denied him which was a huge surprise to me. He's a healthy young boy with no health problems whatsoever. He gets a flare up of excema now and then and I use a cream and it calms down right away. Is it right that they denied him for something so simple or is this just the insurance company being all about the money?

Answer: The Blue Cross Tonik plan is an unusual plan in that the underwriting guidelines differ from those of any other plan that Blue Cross of California offers. The rates and benefits are excellent and are set up in such a way that only people without ongoing health conditions, with few medical exceptions, are accepted on to the plan. Blue Cross have many other offerings that your son would be eligible for so I would recommend contacting them again and reviewing those options. Alternately, there are other plans and insurance companies that would accept your son. Be prepared for a possible increase in premium however.

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