Insurance question

[scuba_898]

I have a BAV and will be having surgery in the near future. I currently have health insurance through my employer and so my condition is not considered "pre-existing". My wifes employer offers better insurance than what my employer does, they are also self insured. many times all the employees have to pay is $20 and everything is covered, no more out of pocket expenses than that. we were not aware of the time limit to add me to her insurance when we were married back in dec. (diagnosed March), her companies open enrollment is November and coverage will start the Jan 1. I am concerned about switching insurances as, i am afraid my condition will then become pre-existing. she has spoken to HR and apparantly the only thing they will ask is if i had insurance for the past year, they do not and can not ask about any pre-existing conditions according to HIPA. Is that correct? I have read of the nightmares that some of you have experienced with insurance companies and coverage. So part of me does not want to drop my insurance for the better coverage. I am only 29 and do not plan to be with this company much longer, so i would end up having to let the insurance go anyway. I believe that i can continue coverage with my current insurance after i leave my job but i would have to pay for it out of pocket, is that correct? Also, I can only have one health insurance plan, is that right? so it would be one or the other but not both?

just looking for a little advice from your experiences. Thanks

 

[AgilityDog]

My understanding of HIPAA is that pre-existing conditions are no longer counted against you so long as you had insurance coverage for the applicable prior period. Which is why you have to take COBRA when you change jobs until you get new coverage, otherwise the new ins. can exclude you for a period on pre-existing.
But I am not an attorney, and do not practice in the area of health law.

 

[Taysgrama]

You can pick up your wife's insurance and not have your condition count as pre-existing because you are already covered by insurance. Also, you can KEEP you insurance as well. Up until I got laid off, we had two health insurance policies on me. Because my birthday fell before my husbands, my insurance paid first then his paid second. We rarely had to pay anything except for our co-pays of $15 per doctor visit and our co-pays on prescriptions. I did not cover my husband on my policy because he does not hardly ever go to the doctor and we really could not afford to pay for the family plan out of my check. My employer paid for my coverage so it was free to me.

Good luck...and if I was you, I would keep my insurance and sign up for my wife's insurance as well. At least until you change jobs.....then you can decide if you want two different insurances at that time!

 

[Lynlw]

AS long as you currently have insurance (and have for the past year I believe) they can't take preexisting conditions into enrolling you or not. IF it at all feasable financially, I would probably keep both insurances. 1 will be the main (primary) insurance that covers whatever they cover and the 2nd (secondary)would pick up any other cost. When I was working we kept both mine and my husbands, because if for some reason one of us lost our jobs we (and mainly my son Justin)would still have insurance. IF you lose/quit your job and don't have another plan you CAN pay for what insurance, you have thru work (I believe it is for 18 months but that part might have changed) BUT It might be very expensive, because you have to pay whatever you normally contributed to the payment PLUS what the employer paid. a couple years ago My Husband was between jobs and I was already not working so we had to do COBRA for a few months just for the 3 of us (for BCBS ppo) it was almost 1400 a month (which is quite alot if you aren't workingand it's ontop of all your other bills)

The main thing you have to do is make sure you NEVER go with out insurance THEN it can and will be a nightmare getting some you can afford with a preexisting condition, but with HIPPA as long as you continuously have insurance (either thru work or cobra) you'll be ok

 

[MarkU]

When we were considering moving me under my wife's work insurance, they required proof that my previous insurance was no longer in place, i.e., no double coverage.

I did recently resign from my old job, and found that I could continue my existing insurance through COBRA for up to eighteen months for $380/month, versus $500/month to add me to my wife's plan. We decided to go the COBRA route for now. I'm now working for a new firm that doesn't currently have a health insurance plan, but plans to offer one within eighteen months.

Worst case is that I would have to move to the wife's plan and pay the higher premium.

FWIW, I did check around again for a private plan. Even though it's been almost nine years since my surgery and I compete in triathlons, no one wants to talk to me. Group plans are really the only option.

Mark

 

[Lynlw]

When we were considering moving me under my wife's work insurance, they required proof that my previous insurance was no longer in place, i.e., no double coverage.

I did recently resign from my old job, and found that I could continue my existing insurance through COBRA for up to eighteen months for $380/month, versus $500/month to add me to my wife's plan. We decided to go the COBRA route for now. I'm now working for a new firm that doesn't currently have a health insurance plan, but plans to offer one within eighteen months.

Worst case is that I would have to move to the wife's plan and pay the higher premium.

FWIW, I did check around again for a private plan. Even though it's been almost nine years since my surgery and I compete in triathlons, no one wants to talk to me. Group plans are really the only option.

Mark

Interesting. I wonder if wether you can have 2 insurances depends on which state you live in. Your cobra was alot less than ours, I guess it just coverred you?

 

[Lisa in Katy]

This is definitely beyond my expertise when it comes to insurance, but I believe the HIPAA law says that as long as you have continuous coverage, they can't use preexisting conditions against you. Whether or not you can have two policies depends on many things. First, like already mentioned, there are policies that won't allow a wife who has access to coverage through her job to be on both policies or to even be on the husband's policy at all. I use "wife" and "husband" to make it clear here because "spouse" for both was confusing, but it can be reversed, or in today's world, same sex partner or non-married couples. This is more common in businesses that employ more males because generally, women are more expensive when it comes to healthcare and they'd rather keep the women off their policy! My husband's policy is written so that I can be on it, but if I have access to insurance through my employer that I am waiving, I have to pay a penalty to be on his which makes it not worthwhile. Also, if either policy is an HMO, they generally don't do Coordination of Benefits, so you've paid for nothing. I'm not sure if there are states that have laws about this.

Unless the deductible is very high for the primary or you are close to the lifetime max for the primary, it is generally not worth it to be on two policies and often confuses the process. In most cases, the secondary ends up picking up the deductible and that's all, so the premiums you have paid are more than the benefit. Read the benefit plans to see how your particular policies work.

BTW - In most, if not all, cases, the plan on which you are the employee will be your primary. The birthday rule generally applies to children with double coverage and is based on which parent has the first birthday.

 

[kfay]

I haven't done insurance stuff in a while,but I believe I'm right about this stuff. Lisa in Katy is our insurance expert and can tell you for sure. If you do switch, they won't count your pre-existing condition as long as you have had continuous coverage for I believe the last 12 months. You can be double insured, they are just going to ask you to confirm that because if you have two insurances, let's say your employer and your wives, your wives insurance is going to make your employer pay first, as your primary, and then they would pay as secondary, any charges left over.

If you know your surgery is soon, I might be hesitant to drop your current coverage. However, I probably would go ahead and add your wives if that is your long term plan anyway.

 

[Taysgrama]

I guess mine was different. We had two PPO plans, one through my job and one through my husbands. Because my birthday falls first (November) and his is in December, mine always paid first then his paid after that. Now, we had our children on 2 plans for a few years and it was always paid the same way. Mine paid first, then his paid second even when he was the patient and was on my insurance. In our case, our deductible was close to $5000 a year, so paying the $100 per month for the second insurance was totally worth it for us. The difference between the annual premium of $1200 and the $5k deductible made it more than worthwhile. Also, because his insurance did not always allow us to pick our own doctor and also required us to get a referral from our PCP before we could see a specialist, it was better to have the two coverages. I see a lung doc (for emphysema), heart doc, spine doc (for scoliosis and other back problems), ortho doc (bad knees and hip) and my PCP, so as you can see, I have alot of specialists that I have to see most every month. We now have just one insurance through my husbands job which is paid for totally by the employer (my granddaughter, husband and I are on the plan) and I do not have to get a referral for any specialist on this plan which is great so I did not have to change doctors. I have been seeing the same ones for years, with the exception of my cardio doc which I just changed to (most of you know the story regarding my old cardio).

 

[bahlvarun]

Well well well...
Now here is where my expertise comes in.
1. Your pre-existing will be asked as part of the enrollment process.
2. Your current Insurance can give a CoCC(Certificate of Credible Coverage) to you and this can be given to your new insurer to waive off the period for any pre-existing that you may be having, check with your new insurer how many years of CoCC needed to waive off your pre-existing notice period.
3. You can have both the insurance go hand in hand, in that case you will have to specify which one will be your primary and which one will be secondary. Any claim will first be sent to primary insurer and then the remaining will be sent to secondary for processing. This is called COB or co-ordination of benefit.
4. Other then open enrollment period like Nov. in your case, there are also qualifying events such as marriage and child birth,you can have out of turn enrollments, but that too is within some period of from the qualifying event such as one month from the date of marriage/birth etc.

I hope this answers your queries, let me know if you have any queries on Health Insurance,I am working with one....

Regards,
Varun Bahl

 

[MarkU]

Interesting. I wonder if wether you can have 2 insurances depends on which state you live in. Your cobra was alot less than ours, I guess it just coverred you?

Yes, the COBRA was just for me. My wife works for the local school board, which has higher rates due to the hight percentage of female employees (particularly ones of child-bearing age).

Again, my wife's school board group plan would not let her add me without written verification that I was losing my previous coverage. It may have been because we were looking to do outside of their open enrollment period. Pre-existing conditions were not an issue.

Mark

 

[Lisa in Katy]

1. Your pre-existing will be asked as part of the enrollment process.
2. Your current Insurance can give a CoCC(Certificate of Credible Coverage) to you and this can be given to your new insurer to waive off the period for any pre-existing that you may be having, check with your new insurer how many years of CoCC needed to waive off your pre-existing notice period.

That's not necessarily true. If you have creditable coverage (12 months in most cases, 18 months if you enroll late) and a break less than 63 days, they usually just add you without collecting additional information. It's not up to the insurer because HIPAA spells it out. There are some states who have additional statutes, but they can't require more than HIPAA. In my state (Texas), an employer that offers group coverage for at least 50 employees can't apply pre-existing condition denials. I've changed jobs 3 times since my surgery and have never been asked for health information. I also changed insurance right before my surgery to go on my husband's HMO during the open enrollment period and wasn't asked for health information.

Again, you MUST check with your policy, but HIPAA is the maximum. If states and/or policies wish to require less, they can.

3. You can have both the insurance go hand in hand, in that case you will have to specify which one will be your primary and which one will be secondary.

No, you don't get to specify which is primary and secondary. As I said, it is almost always decided based on your status as employee or dependent. That is because most, if not all, carriers adopt the NAIC rules. If you are a subscriber on more than one plan, then you can designate, unless it's Medicare and Medicare is almost always primary. Again, this will be spelled out in your policy so before making any decisions, you need to check.

Taysgrama - It does seem that I remember the "birthday rule" being used several years ago for spouses, but as far as I know, it's not used anymore. And yes, as I said, if you have a high deductible, it might make sense to have dual coverage, depending on the premiums.

 

[briansmom]

My only concern would be the fact that you say your wife's company "self insures" - would that constitute insurance coverage if you wife leaves their employ and you have to go to another group?