Oxford To Broaden Enrollment For Adopted Children

Attorney General Spitzer today announced an agreement with Oxford Health Plans under which the company will enroll a member's adopted child in a health plan as soon as the child becomes a dependent, regardless of whether the child is in the United States or abroad.

"New York law is clear - health plans cannot discriminate between adopted and biological children and must allow enrollment when the child becomes a dependent of the plan member, whether the child is at home or abroad," Spitzer said. "Proper and speedy enrollment decisions are especially critical in the case of foreign adoptions because such children may have received inadequate health care and be at increased risk for illness."

The case began when the Attorney General's Health Care Bureau received complaints from Oxford members who adopted, or were in the process of adopting, children in China. The complaining members had family coverage that would have provided emergency and urgent care coverage outside the United States if they had been allowed to enroll their adopted children.

In one case, Oxford told its member that she could not enroll her child until the child began living with her in New York. In another case, parents were told that the children they planned to adopt would not be eligible for enrollment until after the children lawfully entered the United States. In both cases, adoption decrees were final and the children had become dependents of their parents when the parents took custody of them in China.

New York law prohibits insurers and health plans from denying a child enrollment in a family policy on the grounds that the child does not reside with the parent or in the plan's service area. The law also provides that coverage for children who are adopted or placed for adoption is effective no later than the date on which the child becomes a dependent, including during any waiting period prior to finalization of the adoption, if the child is properly enrolled.

Oxford has cooperated with the Attorney General's inquiry. In addition to changing its enrollment procedures, Oxford has agreed to review and remedy previously mistaken enrollment decisions affecting Oxford members, and to provide retroactive coverage of costs incurred.

Not all health plans and insurers offer coverage that applies abroad. Spitzer urged parents who are preparing to adopt to consult with their health plan in advance to determine the extent of their coverage, and to follow all enrollment procedures and deadlines. He noted that some consumers purchase supplemental health coverage when they have concerns about the adequacy of their coverage.

The matter was handled by Assistant Attorney General Vincent Esposito, under the supervision of Health Care Deputy Bureau Chief Troy Oechsner and Health Care Bureau Chief Joseph Baker.

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