[LEJ8]

I am completely new to the idea of special needs adoption, so forgive my ignorance.

Is is difficult to get health insurance on a special needs child? I am considering a special needs child (hep B, missing arm, etc...) but cannot do it if I cannot get insurance for the child. Is it possible?

Thanks in advance for your answers!

[lovemybulldog]

It's my understanding that it's the law that an adopted child be covered under employer based insurance policies at the date of placement with no stipulation of pre-existing condition. I don't know how this is handled with private insurance, but I know our agency required a statement from our employer's HR dept. stating that our child would be covered at placement.

[sak9645]

It all depends whether you have group insurance or individual insurance.

If you have group insurance with an employer that has two or more covered employees, the federal Health Insurance Portability and Accountability Act (HIPAA) applies.

This federal law says that if your policy would normally cover any biological child upon birth, it will cover any child you adopt. The coverage will begin on the date that the child is either adopted or PLACED FOR ADOPTION with you. As an example, if you adopt from China, your child is covered from the day you take custody of her and finalize your adoption. You do not have to wait for an "open enrollment" period.

If you adopt from Korea, your child is covered as soon as you pick him/her up or as soon as he/she is handed to you at the airport, even though you won't have a final decree of adoption. The child will have been placed with you under a decree of guardianship, so he/she is still covered even though you won't finalize the adoption for at least six months in your state's courts.

HIPAA says that your child cannot be excluded from coverage because of a pre-existing condition. Your child also cannot have any particular pre-existing condition excluded from coverage, and cannot be told that the pre-existing condition will only be covered after a wait period. So it doesn't matter whether your child is Hep. B positive, has a cleft palate, etc.

The only important "catch" is that you MUST notify your employer/insuror within 30 days of the date that your child was adopted or placed with you for adoption. If you fail to do so, HIPAA will NOT apply.

The employer/insuror will want evidence of your child's date of birth and of the fact that he/she was legally adopted or placed with you for adoption. Some families adopting from China actually fax their children's Chinese birth certificate and adoption decree to their employer and insuror while still in China. However, in most cases, you can wait until you get home to send along these documents.

Some employers will want you to provide the child's Social Security Number (SSN). The good news is that you can apply for the SSN as soon as you get home with your child. It does not matter whether he/she comes home on an IR-3 or IR-4 visa, whether or not he/she is a U.S. citizen, or whether or not you must readopt in your state. In most cases, you can find out the SSN the day you apply, although the actual SS card won't be sent to you for about two weeks.

If the SS office does not follow the proper rules -- and some staff are not aware that newly adopted children from overseas are eligible -- and it will take more than 30 days to resolve the issue, you can usually convince your employer/insuror that the SSN requirement is NOT part of HIPAA and that it should be waived.

If your employer/insuror will not waive the SSN requirement, or if it fails to understand the requirements of HIPAA altogether, despite actions you may take to educate them, such as printing out the HIPAA rules from the Internet, get an attorney to write a letter to the employer/insuror, explaining the situation and demanding that the coverage be effective as of the date of placement. It IS the law.

Because your child is insured as of the date of placement, you are covered even if you seek medical care for him/her before you have sent your employer/insuror the documentation of your adoption, or before you have received an insurance card.

As far as care sought overseas, your policy probably doesn't cover any medical treatment overseas, even for you; in that case, your child would not be covered if you went to a foreign doctor or hospital with him/her.

If your policy DOES cover treatment overseas, remember that most foreign hospitals and doctors do not accept insurance. What you would have to do is to pay upfront in cash, and then file a claim with your insuror for reimbursement. The good news is that most foreign medical care is downright cheap by American standards, so your out of pocket costs wouldn't be excessive.

Because standard American insurance policies often do not cover care delivered overseas, many families buy supplementary travelers' insurance for the time they will be overseas. Depending on the type of coverage you choose, it could pay for anything from a doctor's visit to emergency evacuation from the country if appropriate medical treatment isn't available there.

If you get back to the U.S. and see your child's pediatrician or a specialist before you get around to notifying your employer/insuror, or before you get an insurance card, you may have to pay for care upfront in cash, and then seek reimbursement from the insuror.

Now, if you do NOT have group insurance, the situation is, unfortunately, very different. HIPAA does NOT apply, and your insuror can usually impose any restrictions and exclusions that it wishes. Many families find, as they begin doing the research for adoption, that their individual policies will not cover adopted children until an open enrollment period occurs, that pre-existing special needs are not covered at all, and/or that coverage for pre-existing conditions will occur only after a certain amount of time has passed.

HOWEVER, do be aware that a few states have laws that extend some or all of the HIPAA safeguards to families with individual policies. It is worth your while to call your state's Insurance Commission to find out if your state has such a law and, if so, what coverage your child will have.

I hope this helps.

Sharon

[momraine]

We have adopted two special needs kids and have had no problem getting either of them on my husbands insurance.