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Utah health insurance companies must offer open enrollment to children twice a year under a new state rule intended to clear up confusion about guaranteed coverage for youngsters.
Last month, just as new federal health reform safeguards barred health plans from rejecting children because they're sick, Utah's largest insurers stopped selling child-only plans. Intermountain HealthCare's SelectHealth is accepting children as long as all insurable members of the family are on the same plan.
But Regence BlueCross BlueShield and other insurers are refusing to do that. Their reasoning: They're waiting for the state or federal government to define an enrollment period.
"This is true even in cases where Mom and Dad are healthy and applying for family coverage for them and their sick child," said Utah Health Division Director Tanji Northrup, who has fielded 10 complaints from frustrated families in the past two days.
Northrup said "some of the larger carriers" were the subject of complaints, but she wouldn't disclose which ones.
The Utah Insurance Department responded Thursday by issuing an emergency rule setting two open-enrollment periods.
The rule applies only to so-called individual plans purchased on the open market. Insurers that don't comply could be slapped with a fine or lose their certificate to do business in Utah.
Northrup isn't convinced the rule is necessary, but issued it anyway to ensure that children have access to the health benefits due to them. She said at least three other states have done the same: Indiana, Ohio and Colorado.
For years — principally in the individual market — insurers have rejected children and adults who have medical conditions, or they would accept them but refuse to cover their pre-existing health problems.
Now such practices are banned for children, and in 2014, will also be prohibited for adults.
The U.S. Department of Health and Human Services estimates that up to 90,000 children will benefit from the law.
But as a concession to insurance companies who worried that parents would wait to enroll children during a medical emergency, federal officials are allowing them to limit enrollment to fixed periods.
"Some insurers did this on their own," Northrup said.
Steve Larsen, deputy director of the U.S. Office of Consumer Information and Insurance, said he welcomes the state's rule.
And Regence BlueCross BlueShield promises to abide by it.
"We are waiting for clarity from the regulators — state or federal — and when that is established, we will, of course, abide by it, whether that be an open-enrollment period or anything else," said company spokesman Mike Tatko. "For nearly 70 years, Regence has provided health insurance to thousands of children and families in Utah. [That] commitment remains as strong as ever."
The rule
The Affordable Care Act bars insurers from denying coverage to children up to age 19 who have pre-existing medical conditions.
The problem
Parents of sick children are still facing hurdles in obtaining coverage.
The fix
Utah insurance regulators are requiring health insurers to offer open enrollment to children twice a year.
The first open enrollment period, from Nov. 1 through Dec. 15, is for coverage effective next January. The second is from May 1 to June 15 for coverage effective July 1.