ADDING YOUR ADOPTED CHILD TO YOUR HEALTH INSURANCE
Parents should add their adopted children to their health insurance immediately upon placement of the child into their home. Some insurance providers may try to deny coverage of the adopted child insisting that parents provide them with a "final adoption order" before they will add the child.
IN MOST CASES this is not true.
Most group health plans are subject to Section 609(c) of the Employee Retirement Income Security Act of 1974 (ERISA) which requires that group health plans that provide coverage for "natural" children must provide the same coverage for adoptive children. The coverage should become effective when children are placed for adoption irregardless of whether or not the adoption has been finalized.
Other group health plans are subject to The Health Insurance Portability and Accountability Act of 1996, (HIPAA), which extends similar requirements to employers and plans not covered by ERISA.
Health plans not subject to either HIPPA or ERISA may still be subject to our Illinois Statute, which is clear that insurance companies may not exclude a child who is being adopted. The statute provides that insurance companies must permit the child to be added when:
The child is in the custody of the insured, pursuant to an interim court order of adoption or,
Placement of adoption, whichever comes first and gives temporary custody of the child to the insured adoptive parent(s) (See below for copy of relevant statutory provision)
ILLINOIS STATUTE ARTICLE XX ACCIDENT AND HEALTH INSURANCE
215 ILCS 5/356h Sec. 356h
"No individual or group policy of accident and health insurance which covers the insured's immediate family or children, as well as covering the insured, shall exclude a child from coverage or limit coverage for a child solely because the child is an adopted child, or solely because the child does not reside with the insured. For purposes of this Section, a child who is in the custody of the insured, pursuant to an interim court order of adoption or, in the case of group insurance, placement of adoption, whichever comes first, vesting temporary care of the child in the insured, is an adopted child, regardless of whether a final order granting adoption is ultimately issued. (Emphasis added) (Source: P.A. 91-549, eff. 8-14-99.)"
The Omnibus Budget Reconciliation Act of 1993 (OBRA'93), Public Law 103-66, amended the Employee Retirement Income Security Act of 1974 (ERISA). The amended law requires that any group health plan which provides coverage for dependent children must provide benefits to a child placed for adoption under the same terms and conditions as apply to a child who is the biological child of a plan participant. OBRA'93 specifically eliminated any requirement that the adoption be finalized in court before there is coverage. The new law also prohibits carriers from restricting coverage of adopted children on the basis of a preexisting condition. The changes implemented by OBRA'93 apply to the medical benefit plans of all employers subject to ERISA. Since ERISA covers almost all employers except government employers, OBRA'93 provided broad coverage to families with adopted children. Basically, although your HR dept and the insurance company may tell you otherwise, insurance is required to cover an adopted newborn just as they would a baby born to you.
For your adopted children to be entitled to coverage under your employer's health insurance plan you must be a plan participant and you must otherwise be eligible to elect family coverage under the plan, and you must follow any other requirements for coverage under the plan.
Some insurance companies may argue that agency's placement papers are not sufficient to initiate adding the child to your insurance because a court did not issue them. You may need to explain to your insurance company that the court does not "place" children for adoption nor do they make "adoption placements" but agencies and/or birth parents do. It is for this reason the legislation was drafted using alternative language to include children who are in placed into adoptive parent(s)' custody "pursuant to an interim court order or placement of adoption". I explain that if the legislature intended the statute to mean "court ordered placement of adoption" it would have written it that way instead of using the words "or placement".
Agencies can and do grant temporary custody to adoptive parents through legally valid placement agreements. These instruments obligate prospective adoptive parents to be responsible for the child's medical health and to consent to all major medical procedures. The reason the statute distinguishes between an Interim Order (the order that is first entered into when clients make their first appearance in court) is because the legislatures and parties to adoption proceedings know that adoptive placements are made prior to going into court. Most often adoptive placements are made weeks prior to going into court for the Interim Order.
If your insurance company or employer is denying your child coverage, you should address these issues in writing and go up the chain of command and deal directly with supervisors, etc. I recommend you email or fax letters as well as mail them to expedite matters. If you receive a denial letter, request an appeal immediately. Retain counsel if needed.
INSURANCE COVERAGE FOR INFERTILITY TREATMENT
Who Must Offer the Coverage?
Illinois law requires insurance companies and HMOs to provide coverage for infertility to employee groups of more than 25. The law does not apply to self-insured employers or to trusts or insurance policies written outside Illinois. However, for HMOs, the law does apply in certain situations to contracts written outside of Illinois if the HMO member is a resident of Illinois and the HMO has established a provider network in Illinois. To determine if your HMO provides infertility benefits, you should contact the HMO directly or check your certificate of coverage.
For More Information
Go to the Illinois Department of Insurance website at:
Call their Consumer Services Section at (312) 814-2420 or
Call the Office of Consumer Health Insurance toll free at (877) 527-9431
or visit their website at http://insurance.illinois.gov/