Benefits/HR people - I need your expertise

[LoveBWVVBR]

My husband's employer has suddenly contracted with a benefits "insourcing" company and they are changing our benefits effective Dec. 1st. I am pregnant and I'm due at the end of Dec.! I can't find any information about maternity coverage with the new plan. It looks like it will still be a BC/BS HMO. Are they obligated to continue my maternity coverage through delivery?

Can they legitimately change medical benefits before the end of the year? I thought that the IRS had rules that said that benefits couldn't be changed before the end of the year once elections were made. DH said that they have to do open enrollment just for the month of Dec. and then they have to redo it in Jan., so I'm wondering if they are being forced to continue our same coverage for Dec. Needless to say, I'm very concerned and I'd love any help that anyone can give me.

 

[diskids2]

There is no longer issue with pre-existing conditions, say thanks to President Clinton for that. Call ahead to the new carrier to ease your worries. Even though you can't find it "in the book", CALL. Take down the name of the person and if you are really worried, call again, get another agent and make sure you get the same answer. Check with your OB/GYN and the hospital to make sure they are "in network". Blue Cross Blue Shield has a big network, so you will probably find no problems.

Enjoy your upcoming new bundle of joy!

 

[LoveBWVVBR]

There is no longer issue with pre-existing conditions, say thanks to President Clinton for that. Call ahead to the new carrier to ease your worries. Even though you can't find it "in the book", CALL. Take down the name of the person and if you are really worried, call again, get another agent and make sure you get the same answer. Check with your OB/GYN and the hospital to make sure they are "in network". Blue Cross Blue Shield has a big network, so you will probably find no problems.

Enjoy your upcoming new bundle of joy!

Thanks! What I'm really wondering is if the new policy could somehow exclude maternity coverage alltogether. I tried to call BC/BS, but they still show my DH's company's group under the current policy with no plans to change. We know that this is not correct. While I certainly can't imagine that a company would suddenly opt for BC/BS coverage w/o maternity when their old coverage had maternity, we can't seem to get a straight answer from anyone! I know that you have to opt for a maternity rider if you buy health insurance independently. Are company policies often sold w/o maternity coverge, though? It seems unlikely, but who knows these days!

We are wondering if we can continue our existing coverage through the birth under COBRA if the new coverage excludes maternity. I'm far from the only pregnant spouse/employee at this company right now, so I'm certainly not the only person who would be affected. I'm am the person who is closest to delivery though as far as I know.

 

[summerrluvv]

Thanks! What I'm really wondering is if the new policy could somehow exclude maternity coverage alltogether. I tried to call BC/BS, but they still show my DH's company's group under the current policy with no plans to change. We know that this is not correct. While I certainly can't imagine that a company would suddenly opt for BC/BS coverage w/o maternity when their old coverage had maternity, we can't seem to get a straight answer from anyone! I know that you have to opt for a maternity rider if you buy health insurance independently. Are company policies often sold w/o maternity coverge, though? It seems unlikely, but who knows these days!

We are wondering if we can continue our existing coverage through the birth under COBRA if the new coverage excludes maternity. I'm far from the only pregnant spouse/employee at this company right now, so I'm certainly not the only person who would be affected. I'm am the person who is closest to delivery though as far as I know.

I've never had group health insurance that didn't come with maternity coverage. I think it's pretty standard, but I could be wrong.

 

[Kim&Chris]

It is extremely unlikely that his company will have a plan that completely excludes maternity coverage. But, to answer your question, you should be able to continue with your current coverage thru Cobra (you'd just pay the premium + 2%). However, I seriously doubt you'd need to worry about that.

 

[Kimberle]

Companies can change insurance companies whenever they want. Mine always changed mid year.

I don't think Cobra applies here. You company is ending it's contract with the old insurance company. Cobra only applies when you actually leave a company.

I would talk to your HR rep and find out exactly what your coverage is. I had a company that changed insurers, and guess what, there was not 1 doctor or hospital in CT (where our home office was) at the start of the plan. The closest was like 2 hours away. They did add them, but not right away.

Don't assume.

 

[LoveBWVVBR]

Companies can change insurance companies whenever they want. Mine always changed mid year.

I don't think Cobra applies here. You company is ending it's contract with the old insurance company. Cobra only applies when you actually leave a company.

I would talk to your HR rep and find out exactly what your coverage is. I had a company that changed insurers, and guess what, there was not 1 doctor or hospital in CT (where our home office was) at the start of the plan. The closest was like 2 hours away. They did add them, but not right away.

Don't assume.

Wow, I never knew any of this until yesterday. I thought that coverage was elected for the plan year (in this case, it was Jan. 1-Dec. 31). I didn't know that they could up and change the insurance at any point.

DH has an appt. with the HR rep. this morning. She is so clueless, though! He already asked her once if our maternity coverage would be changing, and she told him that other pregnant people/people w/pregnant spouses had asked the same question and that she wasn't sure I tried calling the benefits administration company that she works for, but they didn't have any answers for us either. The only thing that I know for sure is that we have a BC/BS HMO right now and that's what we'll have after they change to this new benefits administration company.

If worst comes to worst, can my DH actually resign from his job before the end of Nov. and therefore continue our present coverage via COBRA? Would the company even be obligated to offer that policy under COBRA if they are contracting for the new policy starting Dec. 1st? Would we just get offered (via COBRA) whatever they are offering their present employees at that point? That may be our best option if we have no maternity coverage starting Dec. 1st due to the policy change.

 

[diskids2]

I'm just trying to understand..........Are you changing your insurance coverage or just the benefits administration company?

I really don't think you need to worry about maternity insurance coverage, but I can see why you would want an answer.

Would it really be easier for your husband to resign? Then you would have another issue?

 

[DWDreams]

I think you're probably worried over nothing, but I can understand being a "worrier" person myself.

First, as someone else said, it's very unlikely there would be no maternity coverage, but if that were the case you'd usually see it in what's called a straight indemnity plan not an HMO. An indemnity plan is one that covers certain percentages of certain things and that's it, no hassling with networks etc... An HMO by nature is a network that that covers most items at 100% in network, which would include OB/GYN etc...

I have a BC/BS plan myself, it's a PPO plan which is slightly different than an HMO, but similar and uses the same networks. Now, it happens that my company's corp HQ is in NJ whereas I'm in MA, thus my plan is called BC/BS of NJ, but I know it reverts to the MA network for me. BC/BS has very thorough plans, and one of the largest if not the largest network of doctors. I really think it'll be okay, but it's good that your husband is meeting with HR and finding out these things.

Best wishes on the new addition to your family!

 

[LoveBWVVBR]

I'm just trying to understand..........Are you changing your insurance coverage or just the benefits administration company?

I really don't think you need to worry about maternity insurance coverage, but I can see why you would want an answer.

Would it really be easier for your husband to resign? Then you would have another issue?

Both. The benefits are being "insourced" to some company, AND the coverage seems to be changing. The good news is that we DO have maternity coverage. However, I'm quite certain that this plan will either be changing in January, or else sometime next year. I agree that BC/BS is good insurance normally.

It just seems like this "insourcing" company is up to something...maybe they had to continue out a BC/BS contract through the end of the year or something, but I doubt that we'll have good insurance next year. My fingers are crossed that I deliver before Jan. 1st, that's for sure!

If we didn't have maternity coverage anymore but could have gotten COBRA for this policy, it actually would have been easier for my DH to resign. it would not have been a problem for him to switch to a new job asap. Keeping the same benefits would be more important to us at this point in the pregnancy.

 

[Kermit]

I'm no expert, but I'm under the impression that once a health plan disolves, you can't continue to get coverage under it even with COBRA. If it's gone, it's gone.

I understand why you're worrying, but you will probably have maternity coverage with the new plan, especially if the company he works for isn't very small. I would try to get someone in HR to give you details about the new plan so that you can be using a doctor that will be on both your existing plan and the new plan. You may also have to rework some of the payment details. For example, with our insurance plan, we pay 15% of maternity costs, up to a $2500 out-of-pocket max for each family member. My OB's office charges a flat fee for the whole package, and I have to pay the 15% by the 5th month of my pregnancies.

 

[Kimberle]

If worst comes to worst, can my DH actually resign from his job before the end of Nov. and therefore continue our present coverage via COBRA? Would the company even be obligated to offer that policy under COBRA if they are contracting for the new policy starting Dec. 1st? Would we just get offered (via COBRA) whatever they are offering their present employees at that point? That may be our best option if we have no maternity coverage starting Dec. 1st due to the policy change.

No, don't resign. Your COBRA would be through the NEW insurance company. His company is under no obligation to help you keep your old policy. COBRA means offering ex employees coverage, not their former coverage. You may be able to buy it yourselfs directly from the insurance company.

 

[bicker]

Health care expenses continue to climb, and it does seem that companies are continually faced with the choice of sticking it to either their investors or their employees, or sharing the pain between the two. The employee's share of the pain is often also shared between higher costs to participate in the program and reduced benefits, though I've never heard of maternity benefits being eliminated.

 

[LoveBWVVBR]

Health care expenses continue to climb, and it does seem that companies are continually faced with the choice of sticking it to either their investors or their employees, or sharing the pain between the two. The employee's share of the pain is often also shared between higher costs to participate in the program and reduced benefits, though I've never heard of maternity benefits being eliminated.

I'm definitely relieved that the maternity benefits weren't eliminated. I got worried because the schedule that my DH brought home for this new policy did not show maternity at all. Last year's BC/BS schedule did clearly show maternity, though. You know, I'm really at a loss as to what people will do if healthcare costs keep rising so much. We don't mind paying more if we can buy good coverage, but it seems like we're paying more for less coverage every year.