WHY AND WHEN YOUR HEALTH INSURANCE COMPANY MUST COVER YOUR ADOPTED CHILD

WHY & WHEN YOUR HEALTH INSURANCE COMPANY MUST COVER YOUR ADOPTED CHILD

In 1993 the Omnibus Budget Reconciliation Act of 1993 (OBRA93), Public Law 103-66, amended the Employee Retirement Income Security Act of 1974 (ERISA) and since then requires that any group health plan which provides coverage for dependent children must provide benefits to a child placed for adoption under the same terms and conditions as apply to a child who is the biologic child of a plan participant. OBRA93 specifically eliminated any requirement that the adoption be finalized in court before there is coverage.

However, even today decades later, some group health insurance companies don't follow the law or may make coverage a challenge, and may cause undue stress at a time you don't need it. International Adoption Net (IAN) wants to remind our adoptive family clients or those considering adoption about your rights and the rights of the child you will adopt.

In addition to when the child qualifies for coverage, the law also prohibits carriers from restricting coverage of adopted children based on a preexisting condition. The changes implemented by OBRA93 apply to the medical benefit plans of all employers subject to ERISA. Since ERISA covers almost all employers except government employers, OBRA93 provides broad coverage to families with adopted children.

Health insurance coverage for adopted children is available to all families covered by group health plans as soon as those families assume financial responsibility for the child. HIPAA mandates that group health plans must offer the employee the right to enroll the new child in the plan immediately at time of placement.

Under the law, as amended by OBRA93 and HIPAA, coverage does not begin until the “time of placement”. The term placement, however, is defined in the statute as the time when the adoptive parent assumes financial responsibility for the child which we elaborate means in the US or foreign country when they take physical custody prior to the adoption being approved and final.

What if you don't have a group health plan? Health insurance plans that are not employer-sponsored plans (i.e. individual plans) are not subject to Federal regulation. Those plans are regulated by state law. Fortunately, many states have their own laws that prohibit discrimination against adopted children in connection with health insurance. If you are covered by an individual plan, you should check the laws of your own state to determine your rights and with your health insurance provider.

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