Adoption and Medical Coverage
Adoptive families have historically experienced difficulty when trying to obtain medical coverage for their adopted children because insurance companies have been reluctant to cover the children's special medical conditions. Under a 1993 law (and new 1996 legislation profiled on page 12), however, all employer group health plans that provide coverage for participants' or beneficiaries' dependent children must cover adopted children from the time they are placed for adoption.
According to the Omnibus Budget Reconciliation Act or OBRA of 1993 (Public Law 103-66), insurance companies cannot use preexisting conditions as grounds for denying coverage to newly adopted children. In Section 609(c)(2), the Act states:
A group health plan may not restrict coverage. . .of any dependent child adopted by a participant or beneficiary, or placed with a participant or beneficiary for adoption, solely on the basis of a preexisting condition of such child at the time that such child would otherwise become eligible for coverage under the plan.
"Group health plans" include health and medical plans offered by most every U.S. employer that is subject to ERISA (the Employee Retirement Income Security Act). The only employers that are not subject to ERISA-and are exempt from this law- are governmental entities and churches that elect exemption from the statute.
If an insurance company denies coverage for an adopted child due to preexisting conditions, OBRA 1993 allows the child's parent(s) to make a claim and/or file an appeal with the company. To file a claim or appeal, parents must obtain a written denial of coverage from the insurance company, obtain a copy of the insurance company's policy from their group health plan representative, and make a formal request for appeal or grievance.
From Adoptalk, a publication of the North American Council on Adoptable Children, 970 Raymond Ave., Suite 106, St. Paul, MN 55114-1149; 612-644-3036