Enrolling Children:

Recent federal health care reform laws prohibit insurance companies from denying coverage for children under age 19 based on their health conditions.  However, individual health insurance carriers have limited the time periods for which they allow children to enroll in their plans.

In 2011, there are two open enrollment periods for adding children.   Those wanting to add children to their individual policy or those wanting to buy a separate policy for their children must do so during these open enrollment periods: 

• March 15 – April 30, 2011
• September 15 – October 31, 2011

There are some qualifying events (exceptions) that allow children to be enrolled at other times of the year.  Keep in mind that parents must apply within 31 days of one of the following:

• No longer qualify for a state program.
• Lose coverage due to a divorce.
• Lose employer-sponsored coverage, including COBRA.
• Move & their plan is not available where they live.
• Lastly, parents or guardians can apply year-round for individual coverage within 60 days of birth, adoption, or placement of a child for adoption.

For more information, please see the WA State Insurance Commissioner site. 

Pre-Existing Conditions & Portability:

Something that is often overlooked when purchasing individual plans is the credibility/portability provision.  It’s very important to keep this provision in mind as it may affect you if you switch plans in the future.

"Catastrophic health plans" (as defined by Washington State law) may not be portable if you later enroll on another individual health plan. “Portable” means that you will receive credit for a plan’s pre-existing condition waiting period. Catastrophic health plans generally are not portable, and by enrolling in these plans, you may lose portability rights. 

Here’s a more detailed explanation: 

Most plans require a waiting period of three to nine months for pre-existing conditions (whether or not you received medical advice or treatment).  If you switch plans, you may not receive credit for this waiting period.  It depends on the type of plan you had – more specifically, it depends on whether your plan was considered “portable” or not.  Most high deductible plans (with deductibles of $1,840 or more) are NOT portable.  This means if you have a non-portable plan and you switch to another individual plan in the future, you may have to wait up to nine months for coverage of a pre-existing condition (after your insurance takes effect).

If you are on a plan that is deemed “portable” and move to another plan (regardless of insurance carrier), the new plan must credit your time covered under the portable plan toward meeting the new plan’s pre-existing condition provision. It is simply a credit of time covered.

Here’s an example: 

If you were covered under a portable plan for 2 years and moved to a new plan with a 9 month pre-existing condition provision, the new plan would credit all time covered so you would have already satisfied the new plan’s pre-existing condition waiting period. An analogy is that it works as a bridge from one plan to the new one.

However, if your plan was not “portable,” then moving to the new plan would require you to satisfy the new plan’s pre-existing condition provision. Any condition considered to be pre-existing would not be covered during that time (3-9 months, depending on the plan). This provision now primarily impacts adults and children age 19 and over due to the Healthcare Reform changes for children (as discussed above).

For more information go here. 

Disclaimer:  the information presented here is correct at the time of publishing as is subject to change.