Addressing the issues of employability and insurability remains a challenge for young adults with CHD, their parents, and health care professionals who care for this patient group. Because of their chronic condition, these young persons require ongoing access to health care, throughout their adult lives. Because most individuals obtain insurance through their place of employment (unless it is obtained under a spouse's policy), adolescents with CHD should begin to look carefully at career options that are compatible with their interests and their physical abilities. If it is more appropriate, assistance with referral to vocational rehabilitation programs may be given. Finally, guidance should include how to avoid issues of discrimination during a job interview and when working at one's place of employment. Legislation now supports many workers as long as they can carry out the job for which they were hired. With the continuing rise in cost of health care and health insurance coverage, young persons with CHD must understand the high importance of maintaining health care coverage for their chronic health condition, usually through a group plan in their place of employment. Current legislation supports supplemental coverage and portability of coverage when changing jobs, which minimizes or eliminates waiting periods for pre-existing conditions. Suggestions for ongoing health care are included not only for care by a cardiologist but noncardiac care, including a primary care practitioner, dental care, and obstetric-gynecologic care. With the size and life expectancy of this patient group growing each year, the issues of employability and insurability must continually be addressed by health care professionals in conjunction with government policy makers and insurance representatives. As additional long-term survival data become available on the natural history of CHD, it is hoped that insurance requirements will be modified to afford this group the insurance coverage needed to obtain adequate medical and financial security, with facilitated access to appropriate, high quality, and affordable health care.
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