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Wellmark Suspends Sales of Child-Only Health Insurance

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Wellmark Blue Cross and Blue Shield is suspending sales of child-only health insurance policies as it navigates new provisions of the Affordable Care Act.

Spokesman Rob Schweers said the suspension is temporary, but could be prolonged unless a change is made in a loophole of the law.

That loophole, he said, potentially would allow parents to wait until a child is sick to obtain an insurance policy.

Schweers said doing so would drive up premium rates for others who have insurance.

Wellmark has about 9,000 child-only policies in Iowa, he said. Those will stay in effect and children will still be accepted on other policies.

"To our knowledge, we were the last insurer to still be offering these in Iowa," Schweers said. "If we would be the only company to offer these high-risk policies, it would simply result in higher premiums for our current customers."

Other changes being made by Iowa's largest health insurance provider includes eliminating exclusionary riders and pre-existing condition limitations for children under 19 in non-grandfathered policies, beginning Jan. 1.

Those apply to policies issued before Sept. 23, with customers who are dependents or on child-only policies. Policies issued after Sept. 23 do not have those riders or limitations.

Also, Wellmark customers may add children under age 19 to their existing coverage on a guarantee-issue basis, without underwriting, if a "qualifying event" such as loss of coverage has occurred.

Beginning in 2011, Wellmark non-grandfathered customers who are parents may add children under 19 to their existing coverage on a guarantee-issue basis during a special enrollment period each summer, without the need for a qualifying event.

For new Wellmark customers, children under 19 will be offered coverage on a guarantee-issue basis as part of a family policy throughout the year, as long as the parents qualify for coverage based on their own medical status.

Schweers said Wellmark will be sending letters to its 50,000 individual policy-holders in Iowa, asking whether they want to have their policies grandfathered or not, meaning keeping their insurance as-is, or accepting the new provisions of the Affordable Care Act.

Wellmark insures about 1.8 million Iowans.

Employers will decide whether or not to accept the new provisions or stay grandfathered, Schweers said.