Guaranteed Issue Children Coverage For California Health Insurance

By Dennis Jarvis

The various parts of Health Reform are scheduled to roll out at different times with some early parts already in place now before the big Jan 2014 roll out. One of the more significant pieces dealt with guaranteed issue health insurance for children up to age 18. This has largely been incorporated by the carriers into the market with slightly different approaches but let’s take a look at what to expect with children that have health issues.

Effective September 23rd, 2010, California health insurance for children age 0-18 is guaranteed issue. This means that a child cannot be declined coverage on the standard marketed individual and family health insurance plans due to pre-existing conditions or health. This is a pre-curser to what the rest of the market can expect Jan 1st, 2014 although the exchanges and resulting subsidies are not in place for this initial roll out of child only guaranteed issue coverage. This is the good news and for parents of children with serious health issues, a welcomed relief. It’s important to understand that although coverage cannot be declined to pre-existing conditions, the rates offered can be impacted significantly. Let’s take a look at how the carriers have addressed this rating factor.


We remember the 30 days prior to the Sept 23rd, 2010 roll out with mass updates from the carriers in a frenzied mode. It was clearly a work in progress to figure out the roll out of guaranteed issue as all parties attempted to understand the limits and requirements of the laws. Before we get into the rating factors, let’s look at “tiers” when discussing individual family health plan rates in California.

When you apply for health insurance in California, you generally go in with the quoted rates you find on our website. These are called “Tier 1” rates and are the best rates available on the market. These rates are based on good health and the actual offered rates can change after the underwriting process depending on your health. They generally go up along these lines: Tier 1 – best rates. Tier 2 is 25% higher than Tier 1. Tier 3 is generally 50% higher than Tier 1. Tier 4 might be 100% or more than Tier 1 depending on carrier. There can even be a Tier 5 which might be 200-300% higher than the Tier 1 best rate. These rating tiers have always been available even prior to the Sept 23rd roll out. There also a new 20% increase rating based on tobacco usage which can be accessed in addition to the other tier increases. Now, let’s discuss guaranteed issue coverage tiers for children which partially depends on when they apply.

If your child is applying during an open enrollment window such as during birth month or upon losing parent’s group health coverage, the amount applied may be capped at 100% of tier 1 rates. If applying outside of open enrollment window, the tiers can be very very high with rates between 200-400% depending on carrier and of course, health status/history. A 20% surcharge can be applied additionally for 12 months if the child did not have eligible prior coverage. Ultimately, a child may just qualify based on the original tiers (1-5) above so although the guaranteed issue rates can be high (especially outside of open enrollment), it’s good to have a fall-back option for children with more serious issues. Of course, the impact of this new option is that the rates for all children age 0-18 will go up and have over the past 12 months. We would expect the same thing to happen Jan 2014 when guaranteed issue is rolled out to all individuals as the rates start to catch up with group health insurance rates which have been guaranteed issue for over a decade now. We would be happy to walk through your options when shopping for children’s health insurance in California to make sure this is the best approach.

About the Author: Dennis Jarvis is a licensed

California health insurance quote

agent with extensive knowledge of the Individual California health market.

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