Under the new healthcare law, health insurers cannot decline dependents less than age 19 because of a pre-existing medical condition(s). Effective September 2010, the Patient Protection and Affordable Care (PPACA) guarantees all individuals less than age 19 access to major medical insurance, regardless of health status. Additionally, health insurers and medical plans can no longer exclude or limit the coverage of a pre-existing health condition just because the medical condition is pre-existing. This requirement is called “guarantee issue” medical insurance.
While “child only” major medical insurance plans were widely available pre-PPACA, most health insurers and medical plans have since discontinued offering child only medical insurance policies due to this new requirement. This means young adults and children less than 19 years must be enrolled with an adult. They cannot have their own policy. Why? Since medical insurance coverage is not mandated for every American until 2014, health insurers are concerned about “adverse selection.” This means a spread of risk does not exist because individuals tend to buy insurance when they need insurance. As a result, the health insurer is unable to offer a medical insurance plan at a price that works for the company and the child or young adult, if that child or young adult has a significant medical condition.
Health insurers, however, may still decline adults age 19 and older for an individual medical insurance plan due to pre-existing medical conditions. An existing health condition can also be excluded or limited from being covered under the individual medical insurance plan. Effective 2014, PPACA prohibits this practice by essentially making all major medical insurance guarantee issue.
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