History

• Know the Employee Retirement Income Security Act (ERISA) places the burden on insurance companies to state clearly what they will and won't cover under their policy. The courts generally interpret vague, confusing or missing language in favor of the policyholder.
  
  

Laws

• The Kennedy-Kesselbaum Act requires health insurers to cover pre-existing conditions under group policies. Likewise, states have laws against deceptive trade practices to prevent health companies from denying legitimate claims against their policies.
  
  

Considerations

• Special need health issues are chronic. Families will assume the burden for co-pays, deductibles, out of network providers and meeting yearly policyholder maximums.
  
  

Misconceptions

• Attorney Jeffrey H. Minde writes obtaining coverage for expenses related to special needs is often a matter of educating the claims representative about the necessity of the service, the length of treatment or prescription.
  
  

Types

• Private insurance, Medicaid and Medicare all cover special needs health. Medicaid is available for low income, low resourced people with certain disabilities. Medicare is primarily for those older than 65 years old, but can cover disabilities.