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Wellmark announces implementation of ACA provision regarding pre-existing conditions for children under 19
November 5, 2010

Wellmark Blue Cross and Blue Shield today announced its implementation of the Affordable Care Act provision eliminating the use of pre-existing conditions for children under 19 in the non-grandfathered individual market.

 

For current non-grandfathered* Wellmark individual market customers

For current customers under age 19 in non-grandfathered policies issued prior to September 23, 2010, who are either dependents on a family contract, or who have coverage on their own (a “child-only” policy), Wellmark will eliminate all exclusionary riders and pre-existing condition limitations, effective January 1, 2011. Wellmark individual policies issued on or after September 23, 2010, do not include exclusionary riders or pre-existing condition limitations.

 

In addition, current Wellmark customers who are parents may add children under age 19 to their existing coverage on a guarantee-issue basis (without underwriting), if a “qualifying event” (e.g., loss of coverage) has occurred.

 

Beginning in 2011, current Wellmark non-grandfathered customers who are parents may add children under 19 to their existing coverage on a guarantee-issue basis during a special enrollment period each summer, without the need for a qualifying event.

 

For new Wellmark customers

Children under 19 will be offered coverage on a guarantee-issue basis as part of a family policy throughout the year, as long as the parents qualify for coverage based on their own medical status.

 

As a result of these changes, Wellmark has temporarily suspended new sales of child-only policies, effective immediately. Current child-only customers may continue with their policy as written. This decision does not affect coverage Wellmark provides through the hawk-i program.

 

For information on health and health insurance, visit www.wellmark.com.

 

*As a general rule, policies are considered to be “non-grandfathered” if policy holders have changed their coverage, or have policies with an effective date, after March 23, 2010. Grandfathered policies are not affected by these changes; pre-existing condition limitations or riders that exclude coverage for pre-existing conditions will continue to apply to grandfathered plans in the same manner as today.

Contact Wellmark Media Relations

Traci McBee
Phone: 515-376-4338
mcbeet@wellmark.com

 

Teresa Roof
Phone: 515-376-5869
rooft@wellmark.com

 

1331 Grand Avenue
Des Moines, IA 50309-2901

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