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DORA Insurance News

New Colorado Law on Child-Only Health Plans Prompts
Division of Insurance Emergency Regulation

The Colorado Department of Regulatory Agencies (DORA) Division of Insurance has issued an Emergency Regulation titled: Mandatory Open Enrollment Periods for Carriers Issuing Child-Only Plans.

The purpose of the regulation is to put in place requirements of SB11-128, which became law April 29. “The new law provides a structure so that Colorado children have options and can purchase individual health insurance,” said Interim Insurance Commissioner John J. Postolowski. “The emergency regulation provides specific guidance about child-only open enrollment for the remainder of 2011.”

This year, the open enrollment period for child-only polices will begin on August 1 and end August 31, 2011. The legislation also sets the open enrollment periods for child-only policies to the months of January and July for subsequent years. Coverage obtained during an open enrollment period becomes effective 30 days after the end of the open enrollment period.

A child-only health policy means there is no adult on the individual policy. There can be many scenarios for this type of policy: The parents may be insured through an employer-sponsored plan which does not offer dependent coverage; or the family may not be able to afford coverage for all members, and is seeking coverage for the children only. Life events such as divorce or job loss may also affect insurance coverage.

Children who lose coverage due to a qualifying event can obtain child-only coverage by applying within 30 days of the event. Outside of a qualifying event, a child-only policy can be applied for only during an open enrollment period. Qualifying events include birth, adoption, marriage, dissolution of marriage, loss of employer-sponsored coverage, loss of Medicaid or Children’s Basic Health Plan coverage, entry of a court or administrative order mandating coverage, etc.

Federal Healthcare Reform required insurers writing child-only policies to issue them without regard to the child’s health status or condition. As a result of this requirement, only two carriers in Colorado, Kaiser-Permanente and Rocky Mountain Health Plans, have been issuing child-only policies since fall of 2010. SB11-128 will expand the carriers offering child-only plans to all carriers writing individual coverage in Colorado.

The legislation requires all insurance carriers selling individual health benefit plans in Colorado provide at least one child-only health benefit plan.

The Emergency Regulation, E-11-03, can be found at: http://www.dora.state.co.us/insurance/regs/eindex.htm

For more information on child-only health policies, see the webpage at: http://www.dora.state.co.us/insurance/consumer/Child_Only_Policies.htm