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September 23, 2002


Question from New Berlin, Wisconsin, USA:

My son has diabetes, and we currently insured through my husband’s employer’s insurance plan. However, he is considering returning to school full-time, which would mean an end to our insurance coverage. I’m sure that our diabetic son would be covered by Medicaid (if not by a school-endorsed insurance plan) while my husband is in school, and we’re making very little money. However, my concern regards the time after he graduates. Does an employer have to accept Medicaid or another State-run insurance plan as “creditable coverage”? Could my son be automatically subject to pre-existing condition waiting periods?


From: DTeam Staff

First, I would be careful in assuming that a student health policy offered by a college or university will meet your family’s needs. Many of these policies are designed for “healthy” college students and only offer the flimsiest of coverage; e.g., basic hospitalization, limited physician office visit and not much else. I urge you to read the student policy carefully.

As for the issues regarding creditable coverage, HIPAA provides that most every health plan or coverage, including Medicaid, child health insurance plans and student health coverage issue certificates of creditable. However, States are given some leeway as to whether they require insurers to give credit for such coverage when it is provided by other than an employer’s group health plan. Some states have adopted laws that fully implement the HIPAA portability rules, while others have been more restrictive in requiring insurers to waive pre-existing exclusion clauses. I would suggest contacting the office of the State Insurance Department in the State that you plan to reside in while your husband is attending school.

As for the entire of issue of coverage for your children, whether or not the family qualifies for Medicaid, please look into coverage for the kids through the State’s Child Health Insurance Program. The eligibility standards for this coverage are more generous, the service providers are usually of better quality, and the benefits are more generous. Every State sponsors a CHIP plan, and you can learn more on the web (usually on the state’s web site) or by contacting the State’s social service agency.