ANSWERS: 1
  • <h4 class="dechead">On One Hand: HIPPA Protection for Kids

    Thanks to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), kids born with heart problems are eligible for medical insurance, so long as the parent's employer offers group coverage. HIPAA laws require employer-provided plans to cover their employees and dependents regardless of pre-existing diagnoses. While some cases allow for an insurance company to enact a pre-existing condition clause, in which a condition may be excluded for up to 18 months, kids are afforded special protection by HIPAA. Specifically, according to the U.S. Department of Labor, "Conditions present in a newborn or a child under 18 who is adopted or placed for adoption (even if the adoption is not yet final), as long as the child is enrolled in health coverage within 30 days of birth, adoption or placement for adoption. In addition, the child must not have a subsequent, significant break in coverage (defined as 63 days)."

    On the Other: Private Insurance, Medicaid and CHIP

    Buying private health insurance for a child who has congenital heart problems can mean waiting up to 18 months for coverage of the condition to kick in, and even then, coverage can be limited. Lower income families may have the option of obtaining Medicaid insurance through their individual states, and while Medicaid doesn't deny coverage for pre-existing conditions, access to desired health care providers may be limited. Families who don't qualify for Medicaid financially but who can't otherwise afford health insurance may be able to obtain CHIP coverage (Children's Health Insurance Program). Income eligibility guidelines are determined by individual states, and in order to qualify for CHIP coverage, kids must be otherwise uninsured.

    Bottom Line

    When qualifying kids are properly enrolled in and covered by their parents' employer-provided health insurance, HIPAA protects them from being denied coverage for their congenital heart defects. Buying private health insurance isn't the best option, since a pre-existing condition clause can mean waiting up to 18 months for sometimes minimal coverage. Medicaid and CHIP are health insurance coverage options available to kids from families that meet the income guidelines.

    Source:

    US Department of Labor HIPAA FAQ

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