Tuesday, February 15, 2011


Critical New Window to Sign up or Childrens Health Insurance Highlighted

New Law Ensures Affordable Coverage for Children, Regardless of Pre-Existing Conditions; Open Enrollment Period Ends March 1

(Oakland) – California Department of Managed Health Care Director Cindy Ehnes and Children Now President Ted Lempert joined together with parents and children at a news conference today at the Children’s Hospital Oakland Research Institute to highlight a critical open-enrollment period for kids’ health insurance that ends on March 1. As a result of federal health care reform and California law passed in 2010, children with pre-existing conditions cannot be denied private health coverage.

“One of the most exciting results of health care reform is that health plans can no longer deny or limit coverage to a child under 19 because of a pre-existing health condition,” said Cindy Ehnes, Director of the DMHC. “But parents can’t afford to wait and need to sign up now to ensure their child has a healthier future.”

During the open enrollment period, parents can sign up their children for more affordable health coverage. Until March 1 and during a child’s birthday month, health plans will not be able to charge kids with pre-existing conditions more than double the rate of healthy kids. This opportunity is especially important for parents who previously tried to obtain coverage for their child and were denied because their child was sick, had a pre-existing condition or whose coverage had been limited to exclude coverage for a pre-existing condition such as asthma.

Also under the new law, health plans will no longer be able to exclude coverage for services related to a pre-existing condition of the child. This means that if a health plan previously covered a child for everything but asthma because that was the child’s pre-existing condition, the parents can now apply for coverage without the pre-existing condition exclusion. Parents of uninsured children without pre-existing conditions should also sign up during the open enrollment period, as they may be subject to a 20 percent surcharge on their insurance rates for a full year if they apply for coverage after the open enrollment period ends. Health plans will also not be subject to any rate restrictions outside of an open enrollment period.

“These new insurance protections are a big win for California kids, but parents should take advantage of this first open enrollment period by March 1st,” said Ted Lempert, President of Children Now. “It’s also important to recognize that two out of three uninsured children are already eligible for comprehensive, low-cost coverage through Healthy Families or Medi-Cal. This is a great opportunity to connect all children with the affordable health coverage they need to grow up healthy and strong.”

California passed AB 2244 in 2010 to implement this provision of federal health care reform by ensuring that certain children cannot be denied coverage and by imposing limits on what health plans can charge for such coverage during with the open enrollment period and a child's birth month. AB 2244 also prohibits insurers that sell individual market policies in California from refusing to sell or renew coverage to children with pre-existing conditions – and it bans insurers from the individual market for five years if they do not sell policies to children.

Taking advantage of yesterday’s Valentine’s Day holiday, a special outreach program developed by the health coverage advocacy group, The100% Campaign, was highlighted at the news conference. “Give Your Child a Valentine’s Day Gift from the Heart,” is an informational postcard in both English and Spanish encouraging parents to insure their children and providing guidance on how to get coverage. The postcards are available at www.100percentcampaign.org/.

The DMHC Help Center can provide consumers with more information or assistance if a health plan denies coverage to a child. Consumers can contact the DMHC Help Center by calling (888) 466- 2219 with problems or questions. However, the DMHC does not sell health coverage. To find health plans selling individual and family insurance in your area, visit finder.healthcare.gov, or call the California Uninsured Helpline at (800) 234-1317.

The California Department of Managed Health Care is the only stand-alone HMO watchdog agency in the nation, touching the lives of more than 21 million enrollees. The DMHC has helped more than a million Californians resolve their health plan problems through its Help Center. The Department educates consumers on health care rights and responsibilities, and works closely with health plans to ensure a solvent and stable managed health care system.