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Healthcare Reform Provisions Begin

Janice Simmons, for HealthLeaders Media, September 23, 2010

Grandfathered plans can exclude an adult child under 26 if that child is eligible to enroll in another employer-sponsored health plan, such as a plan through his or her job unless it is the plan of the other parent's employer. But, beginning in 2014, that exclusion will not be available to them.

Approximately 2.4 million young adults are expected to be eligible for coverage under their parents' plans. In 2011, roughly 1.24 million (using mid-range estimates) are anticipated to enroll for dependent coverage; this number is expected to rise to 1.6 million in 2012 and 1.65 million in 2013.

Coverage for sick children: Insurers are prohibited from denying coverage and treatment for children under age 19 with pre-existing medical conditions, such as asthma or cancer. This impacts group plans or "non-grandfathered" individual plans.

The plans can limit when children are signed up to certain open enrollment periods. Plans, though, are not required to sell policies individually to children. (Several plans in California, Illinois, Florida, and Connecticut announced in the past week that they will not be individually selling this particular coverage option.)

Preventive care:  Plans must cover a wide range of recommended preventive services, such as immunizations, well-baby care, mammograms, and colonoscopies, while no longer charging co-payments, co-insurance, or deductibles for those services. This requirement applies, though, only to new plans—and not grandfathered plans.

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