Health Reform Step-by-Step: No More Preexisting Condition Exclusions for Children Under 19
The Patient Protection and Affordable Care Act is a long, complicated document that will cause real changes in the way that you and your family access and pay for health insurance. Texas Impact is committed to helping you understand the bill and making sure that you get the benefits available to you. In the coming weeks, we will pick apart the bill-- starting with the provisions that go into effect in 2010-- so you can see who will be affected.
Prohibition of Health Condition Exclusions for Children Under 19
The Affordable Care Act makes provisions for children who are currently have difficulty obtaining health insurance because of previous or existing health conditions. A preexisting condition exclusion is a plan provision that limits benefits or excludes benefits or plan coverage because a health condition was present before the effective date of coverage.
For health plans beginning on or after September 23, 2010, insurance companies are required to cover young people under the age of 19 who have a pre-existing condition that has excluded them from coverage in the past. This provision applies to all grandfathered and new group plans (including self-insured plans) and all new individual plans. The new provision applies to all under age 19, regardless of employment, marriage or other status.
In Texas, individuals with preexisting conditions have been able to obtain coverage through the High Risk Pool. Now, adults with preexisting conditions can obtain coverage through the federal Preexisting Condition Insurance Plan, if they have not had coverage for the past 6 months and meet certain other eligibility requirements. Beginning in the 2014 plan year, with the health exchange, no preexisting condition exclusions for any individual will be permitted.
For more information on health care options for families, visit www.healthcare.gov.
A Health and Human Services Fact Sheet provides an FAQ about the provision:
Previous Health Reform Step-by-Step articles:
Health Reform Step by Step: An Overview
Extension of Young Adult Coverage
