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Covered California Q&A

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.

Recently in Children's Health Insurance Category

Question: My dependent daughter goes to college out of state. How would coverage for her work?

Answer: If she's covered under your family health insurance policy, he will have out-of-network coverage while out of state. That means a lot more out-of-pocket costs for her routine medical expenses compared to in-network coverage at home. Ideally, she would enroll in the student health insurance coverage offered by her school. That way she get's routine care at school for low or no out-of-pocket expense and major medical coverage under your plan.

Question: We purchased a short term policy for our family when I was between jobs. One of my daughters has pre-existing health conditions (one being asthma). The plan did cover her - but then did not pay for a hospitalzation which they say resulted from her asthma. These type of plans do state that they only pay for emergency care and not routine care and pre-existing conditions - but for children - aren’t they now required by law to cover emergency care related to a pre-existing conditions? Or, are they just required to cover them only for accidents etc… and not for hospital stays related to their pre-existing conditions?

Answer: The main caveat that goes with short-term health insurance is that all medical conditions that existed at or before the date of the application are considered pre-existing condition and thus not covered. So the insurance company was “right” in this case. The ACA rule regarding exclusions in childrens’ health insurance does not apply to short-term health insurance.

Newborn Coverage Options

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Question: I am married but am still covered under my mothers group insurance plan. I have maternity coverage but I am wondering if the insurance will cover the baby after birth and for how long. Also if my husband does not currently have medical insurance will his employer still have to open his enrollment after the baby is born?

Answer: Generally, your insurance coverage will cover your newborn for the first 30 days after birth, but please confirm that with your insurer to make sure. Your husband apparently waived employer-sponsored group health insurance and will not be able to enroll until the his employer’s next open enrollment period. The baby’s birth is not a “qualifying event” for your husband. It would be a qualifying event for the child were your husband insured. You can purchase an individual health insurance plan for your baby in the meantime.

Question: I have a question about the new health care reform. I have a son that just graduated from college and he was on my health insurance where I work (in massachusetts). He will be accepting a new job in california but his company has a "waiting period" of 180 days. So my question is can he remain on my health insurance under the "age 26" law even if he is moving to another state and the fact that even tho hie employer offers health benefits..he cannot get the insurance till the waiting period of 180 days has been completed? Thank you in advance.

Answer: Health care reform - the Affordable Care Act - allows insured parents to keep their sons and daughters on the their health insurance plan (individual or group) to age 26. Since it's a federal law it affects all states equally. When your son moves to California he can stay on your health plan for a few months until he is covered by his CA employer. However, if you have an HMO in MA it will only cover emergencies in CA. PPO works fine out of state. He can get the in-network coverage in CA if he is careful to select the right provider. If HMO, I recommend he purchase short-term health insurance coverage in CA. It's relatively cheap and easy to qualify.

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.

Question: How can I get health insurance for a newborn child when mother is unmarried.

Answer: The marital status of the mother is not a factor. You can purchase child-only health insurance coverage for this newborn baby. If you are a grandparent or other interested party, you can be responsible for paying the premiums. Health insurance rates for infants under 1 year old are higher and this is understandable, because all health insurance plans now include well-child baby visits and routine exams that include blood tests and other diagnostic tests. Start by getting a health insurance quote now.

Insure My Baby

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Question: Should i put my baby on my work insurance or a private plan?

Answer: If your employer pays a substantial portion of the cost for your baby’s coverage and the portion that you have to pay is affordable for you, then go with the employer-sponsored plan. But you may find that your employer does not contribute toward an employee’s dependent coverage. If that is the case you should shop for a child-only health insurance for your baby. Child-only health insurance is a health plan for a child, or children, without an adult on the same policy. Health insurance rates for infants under 1 year old are higher and this is understandable, because all health insurance plans now include well-child baby visits and routine exams that include blood tests and other diagnostic tests. Once beyond the toddler stage, children’s health insurance is more affordable.

Health Insurance for Infants

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Question: Can infants be insured with their own health insurance?

Answer: Yes. An infant can be insured on their own health insurance policy. A parent or guardian must complete an application for child-only health insurance.

A provision of the Affordable Care Act already in effect requires that children under 19 years of age in are eligible to enroll in an health plan without regard to any preexisting medical conditions. Enrollment guidelines vary by state. The California guidelines are listed below.

  1. Annual Open Enrollment Period during the month of the child’s birth date.
  2. Late Enrollment Period, within 63 days of any of the following conditions:

    • Loss of group health coverage because of termination or change in employment,
    • Loss of employer contribution,
    • Death of primary insured,
    • Legal separation or divorce of primary insured causes loss of coverage,
    • Loss of Healthy Families, AIM, or Medi-Cal coverage.
    • Recently became a resident of California,
    • Newborn in California but did not enroll in birth month,
    • Coverage of child mandated by court order,
    • Child is newly adopted.

Question: My older son will be 23 on July 4th. He's now on our family insurance because he's a student. We have received notice that he will he have to get his own coverage. Also, my daughter will be 19 on October 16th. She will not be a full time student at that time. Can she stay on our insurance?

Question: I am a single parent with a job that does qualify my children for all kids coverage under the guidelines, however, when you add my child support into our income, we have too much. My shopping around is getting us nowhere fast, insurance comparable to bcbs is ranging from $590.00-$900.00 a month. What can you suggest? I really had hoped that bcbs all kids would cover them.Thank you.

Question: What is available for the family who makes to much for low cost health insurance, but still is unable to afford health insurance for children

Question: What do I do about this? The court says I have to get insurance for my son in Houston Texas but I live in Wisconsin. I tried to do a application on teh computer but its asking for all kinds of infomation I dont have about him. I didnt even know I had a son until last week.

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?

Child only application

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Question: Can I make an application for my two daughters without me having to be on the plan? I have insurance from my employer but Its too much to add my kids on.

Question: My ex wife and son live in Texas and I've been told by the court to get health insurance for my son. he has PDD NOS so I cant get regular insurance for him. What are my options or maybe I should ask do I have any options at this point?

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