Adoption Health Insurance Issues

Some adopting families and their adopted child are eligible for free health insurance and for those who have private health insurance it is important to know that many insurance carriers are required to offer a child placed for adoption the same access to health insurance as a birth child.

The U.S. federal and state governments administer Child Health Insurance Programs which can help you if your earned income is too high to be eligible for Medicaid but low enough that you can not afford private health insurance.

The U.S. federal law, the Omnibus Budget Reconciliation Act of 1993 requires an insurance company to offer an adopted child the same health insurance coverage as a birth child.  This can be important information in case your insurance carrier tries to deny adoption-related medical expenses that may be covered under this law.

The legal wording and citation as signed into law are provided below:

Subtitle D-Group Health Plans
Sec. 4301. Standards for Group Health Plan Coverage

(a) In General-Part 6 of subtitle B of title 1 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1161 et seq.) is amended by adding at the end of the following new section: "ADDITIONAL STANDARDS FOR GROUP HEALTH PLANS Sec. 609. (a) Group Health Plan Coverage Pursuant to Medical Child Support Orders"

(c) Group Health Plan Coverage of Dependent Children in Cases of adoption

(1) Coverage effective upon placement for adoption

In any case in which a group health plan provides coverage for dependent children of participants or beneficiaries, such plan shall provide benefits to dependent children placed with participants or beneficiaries for adoption under the same terms and conditions as apply in the case of dependent children who are natural children of participants or beneficiaries under the plan, irrespective of whether the adoption has become final.

(2) Restrictions Based on Preexisting Conditions at the Time of Placement for Adoption Prohibited

A group health plan may not restrict coverage under the plan 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 a child at the time that such child would otherwise become eligible for coverage under the plan, if the adoption or placement for adoption occurs while the participant or beneficiary is eligible for coverage under the plan.

(3) DEFINITIONS-.For purposes of this subsection-

            (A) CHILD- The term "child" means, in connection with any adoption, or placement for adoption, of the child, any individual who has not attained the age 18 as of the date of such adoption or placement for adoption.

            (B) PLACEMENT FOR ADOPTION-the term "placement" or being "placed", for adoption, in connection with any placement for adoption of a child with any person, means the assumption and retention by such person of a legal obligation for total or partial support of such child in anticipation of adoption of such child.  The child's placement with such person terminates upon the termination of such legal obligation.