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PPACA: States Scramble to Save Child-Only Policies

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Many states are adopting special open-enrollment periods in an effort to keep new Affordable Care Act rules from chasing carriers from the child-only health insurance market.

The states are setting up the child-only open-enrollment periods in response to provisions in the Patient Protection and Affordable Care Act (PPACA), a major component of the Affordable Care Act, that prohibit carriers that offer child-only coverage from considering pre-existing conditions when deciding whether to sell health coverage to a child.

The provisions are taking effect for health insurance and health plan years starting on or after PPACA RulesSept. 23.

Insurers have warned that letting parents of children with health problems sign up for coverage at any time, without any regard to health status, could lead to severe antiselection, by encouraging parents to pay for coverage when and only when children are sick.

Officials at the U.S. Department of Health and Human Services (HHS) have indicated that they are open to the idea of letting states use scheduled open-enrollment periods to put all child-only carriers on a level playing field and increase the odds that parents will pay for coverage all year round.

Colorado recently announced that it was creating an open-enrollment schedule in an effort to keep carriers in the child-only market.

Indiana, Ohio and Washington state are some of the other states that have

set up child-only coverage open-enrollment programs.

Indiana is letting carriers choose start dates for their open-enrollment periods. Each must offer an open-enrollment period that lasts for at least 30 days.

Ohio is trying to reduce the odds that some carriers will be at a disadvantage by having all carriers start an open-enrollment period Sept. 23 and ending the open-enrollment period Nov. 15.

In the future, Ohio child-only carriers will have to offer open-enrollment periods in January and July, officials say.

Washington state will have an open-enrollment period that runs from Nov. 1 to Dec. 15.

But one major carrier, Regence, Seattle, is dropping out of the state’s child-only coverage market in spite of the open-enrollment period program.

“For nearly a century, Regence has provided health insurance to thousands of children and families in our 4-state service area,” the company says in a statement. “For example, in Washington state, while other insurers abandoned this market in the early 1990′s, we continued to serve this community and our commitment to it remains firm. Our experience tells us the best way to provide coverage to these members is through family policies. Therefore, we will no longer offer individual policies to applicants under 19 except as part of a family policy. Current members on individual products are not affected. This only applies to new applicants requesting new policies. Those currently enrolled in one of these plans are not affected as long as they continue to meet eligibility requirements.”

Regence will participate in the Nov. 1 open-enrollment period for young dependents of new and existing members, the company says.

The Regulatory Framework Task Force at the National Association of Insurance Commissioners, Kansas City, Mo., consiered the child-only coverage topic Monday during a conference call.

The task force has decided to let states decide whether to hold an open enrollment period permissive and to include a drafting note outlining the options that states may want to consider related to open enrollment periods and special enrollment periods, official says.

The task force also will consider creating a definition of “open enrollment,” officials say.


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