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Insurance How To’s for Your Grown-Up Child

One of the most important things you do as a parent or caregiver is to help make sure your children can care for themselves when the time comes. For young adults with bleeding disorders, an important part of this is to be able to obtain health insurance to cover needed treatments. Don’t wait until your child is no longer eligible for your insurance. Learn about the available options.

Permanent Independent Coverage
When your child’s status changes from dependent child to independent adult, he will have three basic coverage options: coverage through an employer; policy conversion from a parent’s plan; and individual (nongroup) policies.

  • Employer-sponsored health insurance. Ideally, your child will find a job that offers group health insurance by the time he turns 19 or graduates from college (see When Does Dependent Coverage Status End?). Often, employers have a waiting period—sometimes 90 days or more—before the coverage becomes effective. If your child does not maintain coverage during this time, he might be subject to preexisting condition clauses, which would exclude all treatment related to his bleeding disorder. To keep this from happening, he needs to continue his existing dependent coverage under COBRA until the employer-sponsored coverage takes effect.
  • Policy conversion from a parent’s plan. If a child’s parent or caregiver has coverage through an employer, there may be a provision allowing the child to convert his dependent coverage to permanent individual coverage. This differs from COBRA, which is temporary. Check your policy or ask your plan’s administrator for more information. A word of caution: Individual policies can be pricey, and your child would not be eligible for future COBRA protection if this coverage lapses.
  • Individual (nongroup) policies. Private policies are available if all else fails, but they often have strict guidelines and pricey premiums. To be guaranteed the right under HIPAA to purchase individual health insurance coverage with no preexisting condition exclusions, your child must meet a number of requirements. To learn more about HIPAA eligibility, you can download a booklet published by the US Department of Health and Human Services. Protecting Your Health Insurance Coverage lists the requirements for HIPAA eligibility, how to maintain existing coverage, and more.

Preexisting Conditions
Normally, health insurance companies will not cover the costs of treatment related to the preexisting condition for a specified length of time, or they may refuse to insure the applicant altogether.

To help people with preexisting conditions, the federal Health Insurance Portability and Accountability Act (HIPAA) guarantees that health insurance can be changed without losing insurability for preexisting conditions. Your child cannot be denied coverage by an employer-sponsored group plan because of a bleeding disorder or other preexisting condition provided he or she meets the following conditions:

  • Continuous credible coverage for at least 12 months before changing plans. (Credible coverage would be insurance through a group or individual plan, Medicare, Medicaid, CHIP, TRICare, state high-risk pool, and any other state or local public health plan.)
  • No lapse in coverage for 63 days or more.

COBRA
Because of COBRA (Consolidated Omnibus Budget Reconciliation Act), young adults usually can continue to be on their parents’ employer group coverage, typically for 36 months, after they are no longer considered dependents.

Here are a few other tips about COBRA:

  • COBRA applies only if the employer group has 20+ employees in the health plan—but there are exceptions. Contact your health insurance plan administrator or your state’s insurance department for more specifics.
  • The plan administrator must notify the person losing coverage within 45 days of coverage termination. They must include information on the amount of the premium, where to send it, and its due date.
  • The applicant must enroll and pay within 60 days of receiving the notification; coverage will end on the termination date, but will be backdated to maintain continuity if enrollment and payment are received within those 60 days.
  • The applicant is responsible for 100% of the premium (that is, the employer does not contribute) and may be charged a small administrative fee.

For more information about COBRA, go to http://www.dol.gov/dol/topic/health-plans/cobra.htm.

Cost of Coverage While coverage can be very expensive, you should help your child understand that ongoing treatments will be far costlier. As they grow into adulthood, remind them that having health insurance will help them maintain their health and financial security. If your child cannot afford to pay insurance premiums, various state programs might be available to help. Contact your local assistance office or Hemophilia Treatment Center for information. You can also contact Patient Services Inc., a nonprofit charitable organization that helps people with chronic conditions to access health insurance. Call 1-800-366-7741 or go to http://www.uneedpsi.org/.