Besides caring for you child and trying to get the best educational and medical services, families of children with special needs have additional practical concerns. Did you know that 60% of bankruptcies are due to medical debt? (Source: Families USA). Healthcare reform should help eliminate some of the financial stress on families. Effective 9/23/10 there are several reforms for children:
- No lifetime caps and limited annual caps
This means that there can no longer be a maximum amount the insurance company will pay over the child’s lifetime. Annual limits are still in effect until 2014.
- No rescinding policies
This means that coverage can’t be dropped when someone gets sick.
- No pre-existing condition exclusions
This means that coverage can’t be denied for a child enrolling in the plan.
- Dependent coverage to age 26
This means that all children, both with and without disabilities, can be covered under their parent’s employer.
- Prevention with no cost share
Wellness benefits are provided with no additional cost to families (for more information on preventive benefits see www.brightfutures.org).
To access free materials from a children and healthcare reform teleconference from the Statewide Parent Advocacy Network, see http://spannj.org/healthcarematerials.htm. The first PDF file was the actual presentation. In addition the entire call recording, including Q&A, will be archived at www.spannj.org/resources/index.htm#Health.
Please note that there are exceptions for “grandfathered” health plans in existence on 3/23/10:
1. These plans must follow the lifetime cap requirements. But only group, not individual, plans have to comply with the limits on annual caps.
2. For pre-existing conditions, it only applies to group, not individual, plans.
3. These plans do not have to follow the prevention requirements
On the brighter side, the federal rules will not override state rules that exceed the new requirements in healthcare reform. For example, NJ already has mental health parity, higher age for dependent coverage, and “guaranteed issue” for pre-existing conditions.
These new provisions should help family caregivers of children with special needs to not have to worry about how they can get their children the care they need.
Resources on health care reform for families of children with special needs:
* Catalyst Center http://hdwg.org/catalyst/news/2010-01-08/2
* Community Catalyst www.communitycatalyst.org/projects/implementing_reform
*Families USA www.familiesusa.org/health-reform-central
*Family Voices www.familyvoices.org/TakeActionHCR.php
*HealthCare for America Now http://healthcareforamericanow.org