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Further Questions Regarding Maryland Health Insurance Coverage for Children

Frequently Asked Questions

More Coverage Issues

When Can A Child Be Added To My Health Plan?

Maryland law allows you to add certain dependent children automatically to your group health plan when you initially enroll, and during open enrollment. For group policies and individual policies, a dependent child is defined as:

1. the natural child, stepchild, adopted child, or grandchild of the insured; or
2. a child placed with the insured for legal adoption.

The child must also be unmarried and meet the definition of a "qualifying child" or "qualifying relative" as defined by the Internal Revenue Service. For policies issued, delivered or renewed after January 1, 2008, certain dependent children of the domestic partner of an insured may also be eligible for coverage by operation of state law. Qualified dependents of domestic partners include:

1. the natural child, stepchild, adopted child, or grandchild of the domestic partner of an insured;
2. a child placed with the domestic partner of an insured for legal adoption; or
3. a child who is under testamentary or court appointed guardianship, other than temporary guardianship of less than 12 months' duration, of the domestic partner of an insured.

The dependent child of a domestic partner must also reside with the insured, be unmarried and meet the same requirements as applied to other dependent children. If you already have a group health plan with family coverage, you may add, during the plan year, a child who becomes your dependent through marriage, birth, adoption, placement for adoption, legal guardianship, or, if you are the grandparent, a grandchild who becomes your dependent. In most cases, you must first notify the health plan and pay any extra premium due within 31 days. If you already have family coverage, and no additional premium is required for the added child, you should still notify the plan within 31 days to avoid denied claims.

If you do not already have a group health plan with family coverage, but are eligible to enroll, you can still get coverage for a child who becomes your dependent through marriage, birth, adoption, or placement for adoption. To do so, you must enroll yourself at the same time you seek to enroll your new dependents. However, grandparents of dependent children, and legal guardians may not have this right. Consumers with individual policies should consult with their health plan prior to the birth, adoption, guardianship, or custody of a child to determine the necessary steps to obtain coverage for the child.

If you are unable to afford healthcare for your child, you should consider the Maryland Children's Health Insurance Program or Maryland's Medical Assistance Program. For additional information about these programs, refer to the earlier section of this brochure, "What Options are Available to Maryland Consumers To Pay For Medical Care"

What Can I Do If My Health Insurance Company Refused To Cover Services Because Of A "Preexisting Condition"?

If you have a history of a health problem, or if you have a health problem at the time you apply for health insurance, in certain circumstances, an insurance company could either refuse to give you a policy or apply an exclusionary rider that excludes your health problem from coverage for a period of time. In some cases, the company may only issue a policy with a rider that permanently excludes the "preexisting condition."

When you fill out the application, you must be as thorough as possible in answering the questions. If the insurer finds out later that you had a medical condition for which you sought treatment or if you have been diagnosed as having a medical condition that you did not tell them about on the application, they can take back the money that they have paid on your behalf, leaving you with unpaid claims.

As discussed in the earlier section, "What Options Are Available..." whether coverage for a preexisting condition can be denied depends upon the type of policy. If you believe your health plan has improperly excluded coverage on the grounds that it is an excluded "preexisting condition," you can appeal the decision to the health plan.

To appeal the decision, make sure to follow the appeal procedure explained in your certificate of coverage or policy and any instructions in the denial notice that was sent to you. You should file your appeal as soon as possible because your appeal may be denied by the health plan if it is past their deadline for appeals. Also, it is a good idea to put your appeal in writing so that you can document what happened, when and what relief you are seeking. The Health Education and Advocacy Unit (HEAU) in the Office of the Attorney General may assist you in preparing your appeal. You can contact HEAU toll-free at 877-261-8807, or via their web site, www.oag.state.md.us. (Complaint forms are available online.) If you are covered by a health insurance or HMO policy issued in Maryland, you only need to file one appeal with the company.

After you have received an appeal decision, if you are still dissatisfied, and your coverage is subject to Maryland law, you may file a complaint with the Maryland Insurance Administration. Our web site, www.mdinsurance.state.md.us has both complaint forms and authorizations to release medical records that you may print out and send to us. You should include copies of the denial letters you received from the company and any other correspondence you have. For further assistance, our toll-free number is 800-492-6116.