There are some major changes to the industry as a whole on the horizon, but not all of them have been implemented as of the writing of this article.
One of the main changes is on preventive care. All health insurance policies must now have provisions for free preventive care which do not even require a co pay to be paid. The preventive care is quite extensive and includes the following services: A free, annual physical for all adults to include “routine blood work”, a routine, annual pap smear for all women over the age of 16, a free, annual mammogram for all women over the age of 35, all routine well baby/child visits including all required immunizations and a free colonoscopy for those over the age of 50. These preventive benefits are automatically included on all Texas health insurance policies written after March 23, 2010.
Another benefit of recent healthcare reform is that all dependent children (age 18 and under) are now “guarantee issue” on all fully underwritten medical plans. Before healthcare reform was passed, everyone, including children, had to qualify medically for a individual or family health insurance policy in Texas.
At first glance, this sounds like a great addition, but there is a catch. When this legislation was passed, our government did not realize that a health insurance carrier still has the right to insure some groups of people at the exclusion of others. Specifically, they are not required to write “child only” just because an application is received.
To date, I’m not aware of a single Texas health insurance carrier that will write a “child only” policy. The only way to insure a child on a fully underwritten individual or family plan (one that includes the free preventive care mentioned above) is if at least one of the parents is on the plan with the child. This at least allows the insurance carrier to collect additional premium in the event the child is very unhealthy and requires extensive medical treatment.
To summarize, if you are attempting to obtain coverage for a child in the individual/family market (not group health insurance), you can either purchase a policy for at least one of the parents and the child together -or- you can purchase a temporary health insurance policy for the child alone (which does not include the free preventive care).
If you have questions on insuring your child, please call us at 866.270.6209 or visit us at http://www.selectedbenefits.com