REQUEST FOR EXCEPTION FOR
HEALTHCARE INSURANCE COVERAGE FOR ADOPTED CHILD
America World requires that all prospective adoptive families have reasonable and sufficient resources to provide for potential physical and mental health related needs, for both themselves and their child(ren) to be adopted. This typically includes traditional healthcare insurance, and typically does not include healthcare sharing programs that do not cover pre-existing conditions or mental health. We recognize that healthcare is a complicated issue, but we also believe it is our responsibility to ensure that adoptive families are as fully prepared as possible to meet the needs of any children they adopt. Since you have indicated that you do not have traditional healthcare insurance, we will evaluate your ability to provide for your child’s medical needs on a case-by-case basis. Please complete the following form to help us in our evaluation. It is important to note that neither families nor America World can ever predict the full extent of a child’s possible medical or psychological needs, and the treatment needs of an adopted child may be extremely extensive and expensive beyond any estimations included in this document or our evaluation.
Name of Prospective Adoptive Parents:
Potential Child Request (age range and types of special needs for requested adoption):
Please research and list what treatments are anticipated for these special needs (medications, labs, surgeries, therapies, etc). Also include developmental therapies that are often needed for children adopted at young ages (speech therapy, occupational therapy, etc), and mental health services (counseling) for children adopted at older ages. We encourage you to reach out to medical professionals, hospital business offices, social workers, and other families who have children with similar needs, to help estimate some of these expenses.
Type of treatment /Anticipated cost
(single event or recurring?) / NotesIf you have a current healthcare sharing plan, what services are included and excluded? Request information specifically about adoption, therapies, pre-existing condition policies, and mental health.
What other healthcare coverage options have you researched in your area?
How do you plan to pay for your adopted child’s medical expenses that may not be covered by your healthcare sharing plan?
What other assets and resources do you have to help with medical or mental health-related expenses? Are there grants or other resources available in your state?
Please outline any additional information regarding resources and your family’s plan tomeet the healthcare needs of the childyou plan to adopt.
We, the family completing this form, understand the risks and expenses associated with providing for the medical psychological needs of the child(ren) we adopt. We understand that there are never any guarantees or assurances regarding the needs our adopted child(ren) will or will not have. We recognize that our future child(ren)’s treatment needsmay be beyond what we expect. We agree to fully provide for the needs of our child(ren) to the best of our ability, and understand this may require significant sacrifice from our family and any other children to whom we may be responsible.
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Adoptive Parent Adoptive ParentDate
AWAA Staff Notes, including approval or denial of request: