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Federal legislation and how California is implementing coverage for children under 19

*Please check with your state to see how they are implementing the federal legislation

The Federal health reform legislation expanded access to health insurance for children with pre-existing medical conditions by requiring insurance companies to offer group or individual health insurance coverage to children under the age of 19, regardless of their medical history. In California, Assembly Bill (AB) 2244, which was signed into law September 2010, established an open enrollment period to apply for these "child-only" health insurance policies, which runs for 60 days, beginning on January 1, 2011.

Following the 2011 initial open enrollment period in California (January 1 through March 1) a child's birth month will become the child's annual open enrollment period. If the newborn child is not enrolled in health insurance during the month that they're born, they'll have an additional 63 days (late enrollment period) to enroll in health coverage. If the child does not enroll in health coverage within the allotted time, the child's application for private health insurance may be assessed a 20 percent surcharge for a period not greater than 12 months. The child may be eligible to enroll as a “Late enrollee” if a qualifying event exists (see below). During which time they may not be subject to the increase in premium.

Qualifying events to be considered a late enrollee outside of the open enrollment period:

  • The child lost dependent coverage due to termination or change in employment status.
  • An employer who provided the child's coverage, either directly or through a parent or guardian, stopped contributing financially toward the cost of the employee or dependent's health coverage.
  • The person through whom the child was covered as a dependent dies.
  • The person through whom the child was covered as a dependent goes though a legal separation or divorce.
  • The child loses coverage under the Healthy Families Program, the Access for Infants and Mothers Program, or the Medi-Cal program.
  • The child is adopted.
  • The child becomes a resident of California during a month that was not the child's birth month.
  • The child is mandated to be covered pursuant to a valid state or federal court order.

It’s important to understand that these enrollment guidelines for CA are in place to prevent consumers from waiting until their child is sick to sign them up for insurance. It maintains a balance between the importance of allowing all children to have access to private health coverage and keeping private non-group health coverage affordable for residents of the state.

Jolene Bibian, RP

Registered ParaplannerSM

Ca Ins Lic # 0E33032

Leon Rousso & Associates

jolene@leonrousso.com