This legislation requires insurers issuing individual health policies to offer at least one child-only policy. A “child-only policy” means individual health insurance coverage for children less than 19 years of age. The policy does not include dependent health insurance for a child under another person’s health insurance.
Insurers must offer guaranteed-issue coverage to primary subscribers under the age of 19 during open enrollment periods or during a special enrollment period within 30 days of a qualifying event. A “qualifying event” means the loss of employer-sponsored health insurance or the involuntary loss of other existing health insurance for any reason other than fraud, misrepresentation, or failure to pay a premium.
A special enrollment period must last 30 days from the date the insurer receives notice of loss of coverage if the notice is provided to the insurer no later than the sixtieth day after the loss of coverage and the loss of other coverage results from:
- Birth or Adoption;
- Marriage or Divorce;
- Loss of employer sponsored insurance Medicaid, or PeachCare coverage;
- Entry of a valid court or administrative order mandating the child be covered; or
- Involuntary loss of other coverage for reasons other than fraud, misrepresentation, or failure to pay premium.
An insurance carrier may deny coverage to an applicant if the applicant is currently enrolled in a high-risk pool insurance policy. In the event that the applicant is a dependent on a policy with a primary subscriber who is over the age of 19, and the primary subscriber drops the policy, the child may apply for child-only policies during the open enrollment period or, in the case of a qualifying event, during a special enrollment period.
Crawford and Boyle, LLC