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Covered California and Obamacare 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 Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.


Child Health Insurance and Exclusions

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Question: We purchased a private plan through Golden Rule / United Health Care in 2009. They excluded coverage for my 7 year old son’s ears for life. Anything at all to do with his ears. Is this considered a grandfathered plan and can they still deny coverage for his ears?

Answer: The Affordable Care Act (ACA), or Obamacare depending on your politics, legislated that no exclusions of coverage would be allowed for children’s (through age 18) health insurance. Most sane individuals would see the intent of the law was to make health insurance for children guaranteed-issue - meaning they can’t be turned down because of pre-existing conditions. The insurance industry chose to interpret the law differently with the result that in most states child-only health insurance is no longer available (California being one of the exceptions) because the insurers refuse to comply with the law’s intent. I guess your son’s health insurance carrier will keep doing what they want until forced not to.

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