Friday, February 18, 2011

California Child Only Health Insurance Plans

5 Days left to enroll children under 19

There are about 5 days left in the "special open enrollment" set up in California to enroll your child at the best rate and without the ability for them to be declined outside of the month of their birthday or a qualifying event.

I hope to provide a couple details here that will be helpful as each carrier is handling this new enrollment period differently. You will have to be a very proactive consumer to make sure you understand how it works. In addition, you may pay more financially for not working with someone who understands this new and ever changing market - so choose and search wisely.


In October/November of 2010 several carriers began pulling out of the California market. Part of the argument was that if required to cover children under 19 at anytime their costs would be unsustainable. However, after some discussion and a plan to help alleviate their concerns of adverse selection many re-entered the market. Albeit, the rules have changed.
(***adverse selection is a term that means; given the opportunity to enroll without the potential to be declined those who have health conditions will be the first to enroll. If this is done without any restraint it is financially unsustainable for any insurer. If you would like a more technical explanation go to wikipedia here***

Enrollment Periods

There are now new enrollment periods for children under 19 who apply for an application independent of their parents. Unlike adults who apply who can still be declined for health reasons, children are now guaranteed issue (meaning they cannot be declined for any reason). It is important to understand and not mistake guaranteed issue with insurance rates or insurability. What that means is that though they can now apply and not be declined they can still get a higher rate based on health conditions. The time in which you apply can make all the difference in how high that rate can be.

Below is the most recent status on how carriers are handling this enrollment period (updated as of 2/18/11):

Blue Cross - Open enrollment Jan 1 - March 1. If not enrolled then there is another open enrollment one month after birth date. (Blue Cross said that they sent an email blast yesterday ( (February 17)) at 3:00pm with new children policy information - we will write more when we get it as we did not).

Aetna - Open enrollment Jan 1 - March 1. If not enrolled then there is another 63 days after qualifying event. They are only accepting paper applications for child plans. (Information on child policies is to be posted on their web page (Producer World), but has not been posted yet)

Health Net - Open enrollment Jan 1 - March 1 (midnight) and then 30 days after qualifying event.

- Open enrollment Jan 1 - March 1 and then 30 days after qualifying event.

Blue Shield - Open enrollment Jan 1 - March 1 and then 30 days after qualifying event. Blue Shield has a series of rules that we will write more about. For now, you need to apply before the 15th for a 1st effective date. If you apply from the 16th-31st your next closest effective date will be 1st of the following month. (There are a lot of details here but that is the high level and short answer).

Ross W. Pendergraft, an insurance broker in Southern California, and on the Board of NAHU (National Association of Health Underwriters), has put together an informative piece with some additional information on options for children that you can find here.

Other options include; Coverage For All (here), find a health insurance broker on the NAHU website (here) or call our office at 650-419-2403.

As a side note...

Part of the debate regarding individual mandates is more about the financial viability of the exchanges and avoiding adverse selection than it is about it's constitutionality. I am not taking a political stance on this but simply pointing out that if it is, in fact, deemed that PPACA is unconstitutional by the Supreme Court those who understand insurance know there has to be a corresponding solution that deals with the bigger issue. That bigger issue is figuring out how you get enough healthy individuals to enroll so that the whole exchange is financially stable to subsidize those who are not healthy and who will be the first to enroll. Of course, that is a topic we can address further in the future.

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