State's child-insurance law starts Jan. 1
New state law offers greater protection than federal statute does
December 30, 2010|By Victoria Colliver, Chronicle Staff Writer
A state law that takes effect Saturday goes further than the federal health law when it comes to making sure children with pre-existing medical conditions can get health insurance coverage.
A provision in the federal law, which took effect Sept. 23, bars insurers from denying coverage to children who have medical problems.
But many of the largest health insurers in California and other states initially stopped issuing new child-only policies because they were concerned that parents would wait until their child got sick before getting insurance. Most of those insurers announced last week they will return to the market in California and comply with the state and federal laws.
The new state law, authored by Assemblyman Mike Feuer, D-Los Angeles, and signed into law by Gov. Arnold Schwarzenegger on Sept. 30, bars insurers that refuse to sell policies exclusively for children from the broader individual market for five years. It also limits the amount insurers can charge for covering children with serious health conditions to no more than twice what they would charge healthier children.
While it allows parents to sign up their kids for coverage year round, the new law discourages them from signing up outside specific "open enrollment" periods by allowing insurers to charge higher premiums. The enrollment periods include the first 60 days from when the law goes into effect, the child's birthday month and after certain events, such as the loss of insurance coverage.
"Insurers can no longer discriminate against the sickest children by denying them coverage or charging exorbitant premiums," said Kelly Hardy, director of health policy at Children Now, a national children's rights group based in Oakland.
Legal haze
Because there's no legal definition of a pre-existing condition, Hardy said such conditions can include anything from an ear infection to asthma or autism. She said an estimated 576,000 children in California have been diagnosed with a condition that could lead to denial of coverage.
Hardy said her group and other children's health advocates are working with the California Department of Insurance and Department of Managed Health Care to get the word out to parents about the open enrollment periods.
The insurance department last week issued guidelines that clarified various aspects of the new law, such as the fact that insurers must offer coverage to those under 19 for every individual policy the insurers sell - not just select, limited policies.
