Insurance question...

[Imran Siddiqui]

Theben, did you have such a break for over 63 days? The one thing that really 'gets' employers, though, is that they don't tell people (in writing) what the preexisting exclusions are. That's a no-no and blocks them from saying it later... if the participant knows the law.

Btw, if they have violated the law, and the company won't do jack (ask to speak to the Plan Administrator at your company's corp HQ), call 1-866-444-EBSA (3272).

[Theben]

Originally posted by Imran Siddiqui
Theben, what you are describing is pre-existing condition exclusion. The way it works is this. If you recieve treatment or diagnosis for a condition within the 6 months before you join your job, a new health plan may deny coverage for that health condition if you did not have continous coverage (without a 63 day break in coverage) before that for 12 or 18 months.

Basically, the new plan may assign a 12 month (or 18 month if you joined up under special enrollment.. ie, if you lost coverage somewhere else and joined under a family member's plan) pre-existing condition exclusion. HOWEVER, this 12 months is offset by any creditable coverage you had before. Any coverage you had after a 63 day break in health coverage (creditable coverage) is used to offset this 12 month exclusion.

So the question is when did you get coverage with your current employer and what were the dates of your previous insurance... and did you have a 63 day break in coverage?

If you had more than 12 months continuous coverage without a 63 day break in coverage, you can prevent pre-existings by showing your current insurance a Certificate of Creditable Coverage, which you can get from your previous employer/insurance.

Oh, and if you were curious, this stuff (HIPAA) is part of my job .

edit: Oh, almost forgot, to ENFORCE a preexisting condition exclusion, they have to tell you, specifically, which condition they are excluding and for how long when you join up. If they didn't, they are in violation of ERISA, and are not allowed to exclude that.

It was an 85 day break in coverage. COBRA was just too damn expensive.

However I didn't see anything wrt specifics mentioned prior to enrollment (and I looked), and as rah said I've avoided seeing the doctor so as to not be 'diagnosed'. My concern was it's something that has been a problem for a while and it's obvious that I would have known about it.

[Theben]

Originally posted by Imran Siddiqui
The one thing that really 'gets' employers, though, is that they don't tell people (in writing) what the preexisting exclusions are. That's a no-no and blocks them from saying it later... if the participant knows the law.

Btw, if they have violated the law, and the company won't do jack (ask to speak to the Plan Administrator at your company's corp HQ), call 1-866-444-EBSA (3272).

I have to check to make sure, but that's sounds like good advice. Thanks!

[Imran Siddiqui]

Originally posted by Theben
It was an 85 day break in coverage. COBRA was just too damn expensive.

However I didn't see anything wrt specifics mentioned prior to enrollment (and I looked), and as rah said I've avoided seeing the doctor so as to not be 'diagnosed'. My concern was it's something that has been a problem for a while and it's obvious that I would have known about it.

About COBRA, did your prior employer send you a COBRA notice? And how long ago was this employment (may help you).

If you haven't seen or gotten diagnosed by a doctor about the condition for 6 months BEFORE you signed up with the plan, then they would be violating the law if they assigned pre-ex. Also, they are required by ERISA to provide you with a written notice when you join about what exactly is pre-ex.

Usually a lot of this crap can be stopped if you call your Plan Administrator (usually the HR Director at your company) and tell him all that and that you've spoken to someone at the Department of Labor (you have... me).

If that doesn't work, call the EBSA line. I'm not sure how good the Chicago office is in dealing with issues like HIPAA pre-ex, but they should be able to help somewhat. If they blow you off, let me know, I may be able to get you some help (I can ask someone in the Atlanta office to make some calls on your behalf).

[Theben]

Employment ended on may 31. I worked for them almost 5 years. YEs they sent a COBRA notice. And since my previous employer was family, I'm not taking any action against them (and the company's defunct anyways).

Most of what I want looked at hasn't been diagnosed yet, or was within 6 months.

[Imran Siddiqui]

You mean or "wasn't withing 6 months"?

Yeah, if you didn't get treatment or diagnosis in the 6 months before you joined the plan for that ailment, they can't pre-ex you. If you call, and they tell you that you had a break in coverage for too long, just keep telling them that you know, but you didn't have any treatment or diagnosis for that issue in the 6 months prior to joining the new plan.

[Theben]

Ok.

[Mrs. Tuberski]

Dam Imran thats impressive. Your knowledge of this hippa and erisa. Hell every time i go to a new hospital this crap is drilled into our skulls. I often wonder how much of this do we really need to know and memoriaze. apparently jacho is the required persons demanding this stuff

[KrazyHorse]

Like he said: it's his job.

[Mrs. Tuberski]

Originally posted by KrazyHorse
Like he said: it's his job.

wow i can read that too, but last i heard he passed the bar to be a lawyer my bad i didnt ask what type of lawyer he was.

[Spiffor]

Originally posted by Imran Siddiqui
When you don't have any health coverage. It happens quite frequently, especially when people switch jobs or when kids get too old to be covered on the parents' plan.

So, basically, if you have two monthes of downtime between two jobs, you might not be reimbursed for your heart problems for the whole duration of your new job*?


*(as I understand, health insurance is closely linked to your job. You have pretty much the same health insurance as long as you keep your job. Tell me if I'm wrong)

[Aabraxan]

Originally posted by Imran Siddiqui

Apparently insurance companies do consider pregnancy a pre-existing condition or precondition.

IIRC, they aren't supposed to.

Maybe not, but I've seen exclusions like "must be covered by the Plan for 12 months prior to conception or we won't pay for the birth."

[Theben]

Originally posted by Spiffor

So, basically, if you have two monthes of downtime between two jobs, you might not be reimbursed for your heart problems for the whole duration of your new job*?


*(as I understand, health insurance is closely linked to your job. You have pretty much the same health insurance as long as you keep your job. Tell me if I'm wrong)

Two months between insurance carriers. You're right that jobs and insurance are closely linked, in that many jobs offer health care plans to employees. Lose the job and you're no longer eligible for the plan most of the time. The fed program COBRA allows people to continue insurance coverage, but basically all it is is a guarantee to continue the previous coverage, except that now the (unemployed) person has to pay the whole thing.

[Spiffor]

Just to get an idea, and if it's not too personal, how much would have your COBRA cost, and what was your income during unemployment?

[Flubber]

reading this thread, I am so so happy to live in Canada. Its simple here, if you get sick, you get treated.


On insurance generally-- remember people its for contingent things ie things that might happen, not things that you know will happen. Otherwise EVERYONE would just wait to get sick to buy it. While my understanding is that many insurance companies are pretty cut-throat, even if they were the kindest gentlest insurer in the world, they could not routinely cover pre-existing conditions and survive