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.