by Guest » Thu Sep 29, 2011 08:32 am
I thought that HIPAA guidelines outline certain groups as falling outside the open enrollment restrictions. These include the birth of a child, the adoption of a child, or the placement of an adopted child.
However, my insurance company is telling me that the 5 year old I adopted last week must adhere to their open enrollment restrictions. Therefore, this special needs child, who requires immediate care, will have to wait until the spring of 2012 to be placed on my insurance policy. Alternately, I will be forced to buy a more expensive, separate policy for my son, but that policy cannot begin until December 1. This means that my son will be uninsured for two months, during a time that he needs medical care.
How can my insurance company choose not to adhere to HIPAA guidelines on this issue? Or am I missing something?
However, my insurance company is telling me that the 5 year old I adopted last week must adhere to their open enrollment restrictions. Therefore, this special needs child, who requires immediate care, will have to wait until the spring of 2012 to be placed on my insurance policy. Alternately, I will be forced to buy a more expensive, separate policy for my son, but that policy cannot begin until December 1. This means that my son will be uninsured for two months, during a time that he needs medical care.
How can my insurance company choose not to adhere to HIPAA guidelines on this issue? Or am I missing something?
Posted: Thu Sep 29, 2011 12:09 pm Post Subject:
You may consider contacting your state’s insurance commissioner’s office, regarding this issue. Usually the new placement of an Adopted Child is an exception to the rule under HIPPA laws.
Posted: Thu Sep 29, 2011 08:18 pm Post Subject:
For HIPAA to apply in your situation, the health insurance plan must be employer-sponsored. HIPAA doed not apply to individual health insurance plans. If your plan is individually-issued, not an employer group plan, you may have different rights under state insurance laws.
Assuming your plan comes from your (or your spouse's) employer, here's what the US Dept of Labor Employee Benefits Security Administration's (EBSA) FAQ page has to say:
What events trigger a special enrollment opportunity?
When the employee or dependent of an employee loses other health coverage, a special enrollment opportunity in the group health plan may be triggered. To have a special enrollment opportunity in this situation, the employee or dependent must have had other health coverage when coverage under the group health plan was previously declined. If the other coverage was COBRA continuation coverage, special enrollment can be requested only after the COBRA continuation coverage is exhausted. If the other coverage was not COBRA continuation coverage, special enrollment can be requested when the individual loses eligibility for the other coverage.
In addition, a special enrollment opportunity may be triggered when a person becomes a new dependent through marriage, birth, adoption or placement for adoption.
For each triggering event, a special enrollee may not be treated as a late enrollee. Therefore, the maximum preexisting condition exclusion period may be applied to a special enrollee is 12 months, and the 12 months are reduced by the special enrollee's prior creditable coverage. In addition, a newborn, adopted child or child placed for adoption cannot be subject to a preexisting condition exclusion period if the child is enrolled within 30 days of birth, adoption or placement for adoption and has no subsequent significant break in coverage.
If HIPAA applies, as outlined above, you have two options: (1) Go to the employer's HR Dept and DEMAND your newly adopted child's rights under HIPAA and/or (2) Contact your regional EBSA office and file a complaint immediately -- due to the urgency it will receive priority attention.
Find your regional EBSA office here: http://www.dol.gov/ebsa/aboutebsa/org_chart.html#section13
Don't delay in this!!
Posted: Fri Sep 30, 2011 09:21 am Post Subject:
Thank you so much for your valued information. I will be doing as you said at the earliest, as I do have the health insurance under my employer.
I hope they will consider my situation and take action as soon as possible and my son won't have to suffer for it. Thanks again.
Posted: Fri Sep 30, 2011 12:00 pm Post Subject:
I hope they will consider my situation and take action
They have to do this. HIPAA requires that coverage begin no later than the first day of the month following the enrollment application for coverage. You have only today to enroll in order to have your child's coverage start tomorrow.
Add your comment