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Group Health Plans Cannot Deny Coverage to Adopted Children:
It's the Law
Buried deep in the Omnibus Budget Reconciliation Act of 1993 is a provision that guarantees adopted children the same access to health insurance as birth children.
For families faced with insurance denials, legal wording and citations 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.
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