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PPACA: HHS Bends on Child Pre-existing Condition Rules

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The U.S. Department of Health and Human Services (HHS) says it will let health plans use a structured open enrollment period to implement a ban on pre-existing condition exclusions for children.

A provision in the Affordable Care Act, the package that includes the Patient Protection and Affordable Care Act (PPACA), will prohibit health plans from imposing pre-existing exclusions on children under age 19 starting with policy years beginning on or after Sept. 23.

Some insurers had started to drop child-only health insurance product options, arguing that rules requiring them to sell coverage to children on a guaranteed-issue basis could lead to rampant adverse selection, encouraging parents to buy coverage when and only when their children are seriously ill.

HHS officials now say they will let individual health carriers discourage adverse selection by selling individual health coverage to children only during regularly scheduled open enrollment periods.

America’s Health Insurance Plans (AHIP), Washington, has put out a statement welcoming the announcement.

“For years, structured enrollment periods have been used in the Federal Employees Health Benefits Program, Medicare, and in employer-based coverage to minimize disruption for families, seniors, and small businesses,” AHIP President Karen Ignagni says in a statement. “Health plans are committed to working with federal and state officials to ensure consumers are aware of all of their coverage options, including how and when they are able to sign up for coverage.”


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