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Child-Only Health Plans

On September 23, 2010, many of the larger consumer protections in the federal Affordable Care Act took effect. Under the new federal health care reform law, insurance carriers in the individual (non-employer) market can no longer deny coverage to a child with a pre-existing condition.

In the 2011 legislative session, the Colorado Legislature passed and the Governor signed Senate Bill 128. The new Colorado law takes an additional step by requiring any insurance company that sells individual policies to adults and families, to also sell child-only policies.

Below are some answers to the questions you may have about child-only health plans.

 

mother and child

 

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Any insurance carrier that participates in the individual market must also sell child-only policies.

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Like many employer plans, there will now be "open enrollment" periods when child-only policies can be purchased. The open enrollment periods are held each January and July for the entire month.

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A qualifying event is defined in the new Colorado law as birth, adoption, marriage, dissolution of marriage, loss of employer-sponsored coverage, loss of eligibility for Medicaid or Child Health Plan Plus (CHP+), entry of a valid court or administrative order mandating the child have coverage, or involuntary loss of existing coverage other than because of fraud, misrepresentation or failure to pay premium.

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Yes, but only if a qualifying event occurs. If a qualifying event occurs, the application must be received by the insurance carrier within 30 days after a qualifying event.

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Yes. A carrier may deny coverage if the child has access to other creditable coverage, such as a parent’s plan through an employer.

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Employees can seek coverage in the individual market for children who are not covered by an employer’s insurance plan during the open enrollment period.

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Yes, a premium on a child-only policy may be higher because of the child’s pre-existing condition. However, the carrier cannot deny coverage because of the pre-existing condition.

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Coverage is effective after a 30 day-waiting period following the end of the open enrollment period.

Division of Insurance regulation on child-only policies pdf file

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