Health Insurance Question

[alexandmaddie]

Hi, I'm wondering if anyone can help me with an insurance question.

My DH is changing jobs and his new health insurance does not kick in until 30 days after he starts there (which would be Sept. 1st). Our current insurance will end on July 31st. I realize that we can COBRA for the month of August, but the cost to do that is around $1200 for one month.

I was looking into a short term plan with Blue Cross Blue Shield, but they will only sell in 30, 60 or 90 day increments. Unfortunately, August has 31 days. So, we would be short by one day if we started on August 1st.

The phone rep suggested to me that we start it on Aug. 2nd, then we'd have the 30 days covered and she said that we could just go back and pick up the COBRA for August 1st if something catastrophic happened. Does anyone know if this is indeed true? Can you go back and pick it up if something were to happen on that day?

Thanks. Krista

 

[Eeyore1954]

You cannot purchase health insurance to cover a past event. You must purchase the coverage in advance and it has to be in effect on the date the claim event occurs. I am not sure what this BCBS phone rep is thinking, but I don't believe you can do that. Purchase the coverage in advance to be safe.

 

[caitycaity]

Within what time period does the Qualified Beneficiary have the option of electing COBRA?

A qualified beneficiary may elect COBRA coverage at any time within 60 days after the date plan coverage terminates, or, if later 60 days after the date of the notice to the qualified beneficiary from the plan administrator. The 60-day period permits a qualified beneficiary to "adopt a wait-and-see approach to continued coverage, and then elect if and when medical care is required during the election period. If the plan administrator has not sent the notice of qualifying event, the election period remains open. The 60 day period is a minimum.

http://www.cobrainsurance.com/COBRA_FAQ.htm

You, your spouse, and children have 60 days to decide whether to buy COBRA. This election period is counted from the date your eligibility notification is sent to you or the date that you lost your health coverage, whichever is later. Your COBRA coverage will be retroactive to the date that you lost your benefits (as long as you pay the premium).

http://insurance.yahoo.com/lh/cobra.hin.html

however, from what i understand, if you do not have continuous coverage (even for one day) HIPAA protection in terms of pre-existing conditions no longer applies to you and you could be denied for health insurance.

if i were you, i would probably just pay for COBRA for 1 month.[

 

[Maleficent13]

I have worked with benefits in the past, and it is my understanding that if you elect COBRA within the 60 days following termination, it is indeed retroactive to the first day following termination. Therefore, there would be no uncovered days, and pre-existing clauses would not apply.

More specifically, when beginning a new insurance plan, most ask for a letter of continuous coverage from your old plan, to insure there was no lapse in coverage. If you COBRA any time in the 60 day window, your letter would read: "Beneficiary was covered under XYZ plan from July 1, 2001 through August 31, 2004." There would be no delineation as to what was the COBRA part of that coverage.

Disclaimer: I have not worked in benefits in over 5 years, and HIPAA may have made a difference, as caitycaity mentioned. I encourage you to check with your soon-to-be plan to make sure that this is their policy before making any decision. Also, call back and speak to a different rep at the stop-gap plan you are considering. Get the info from several knowledgable people to make an informed decision. FWIW

 

[Tiggeroo]

I believe that there was a change in fed. regs. You can have a lapse in coverage for up to 90 days and still have existing conditions covered. And you have 60 days to choose to pick up cobra. If that's the case then you could do nothing, and if an emergency came up, pick up cobra and your coverage would be back dated. I do know I picked up cobra and it backdated coverage for a claim from before I picked it up.

 

[Eeyore1954]

I sit corrected then. Thanks CC and Mal! I would second the suggestion to purchase COBRA now to ensure your HIPAA coverage.

 

[mickeyboat]

Check with your new carrier on time periods for coverage of pre-existing conditions. I think you can be un-insured for up to 90 days in the previous year before you will be denied coverage.

However, I would be afraid to risk the one day of not being covered. Would it be cheaper to purchase the short term coverage through BCBS for 60 days or to pay for COBRA coverage for $1,200?

Denae

 

[alexandmaddie]

Thanks for the replies, everyone.

Wow, who knew this was all so confusing. I think what I will end up doing is purchasing the 60 day short term plan - even though we only need 31 days. The cost for 60 days is $385 as opposed to $1231 for the Cobra for one month.

So, if I get this short term plan, will that mean I have continuous coverage for HIPPA? Or will I be considered having continuous coverage only if I elect the COBRA coverage? This is where I get really confused.

No one in our family has any pre-existing conditions as of right now. We have all had our check up's for the year and are in good health. I do realize that things come up and accidents happen, so we are not willing to go without insurance. I just want to try and do things the most cost effective way.

I will make some more phone calls, I guess. Thanks!! Krista

 

[Maleficent13]

Originally posted by alexandmaddie
Thanks for the replies, everyone.

So, if I get this short term plan, will that mean I have continuous coverage for HIPPA? Or will I be considered having continuous coverage only if I elect the COBRA coverage? This is where I get really confused.


I will make some more phone calls, I guess. Thanks!! Krista

If you get the short term plan for the dates you talk about, you will have continuous coverage. It doesn't matter what plan you have, just that you have a plan.

 

[llp479]

Under HIPAA they can only involk the pre-existing clause for the amount of time in which you were not covered. So, if you were uncovered for 30 days, then that would be the amount of time they would be able to involk the pre-existing condition clause.

I would also go with the short term plan. Better safe than sorry!DD fell off her bike two weeks ago and ended up breaking her arm andrequired surgery to fix it!

 

[manchurianbrownbear]

alexandmaddie,

I'm posting from my desk at a Twin Cities HMO, Medica. I have answered this question dozens of time for my clients!

As the quotes in Caity's post state, you may elect COBRA coverage AT ANY TIME within the 60 days after your current plan terminates. Even if it is after you've received care.

And, per current HIPAA regulation, you have continuous coverage as long as your lapse in coverage is less than 63 days. So, if your current plan expires 7/31/04 and the new plan (I hope its a Medica plan ) becomes effective 9/1/04, you, by law, will have maintained continuous coverage.

If something would happen in between 7/31/04 and 9/1/04 you are still within the 60 day window in which you can elect COBRA coverage.

IMO, your best option would be to not take the short term policy and not elect COBRA unless you receive care in August that costs more than COBRA premium would be for that month.

 

[alexandmaddie]

Manchurianbrownbear: Thank you so much for your reply!! Those are very interesting facts!

DH currently works at Mayo (drives to Rochester everyday from Woodbury). He just accepted a position in Minneapolis. Our new insurance will be with Medica!! I was going to go with Medica's Short- Term Choice Solution because it is $65 cheaper than BC/BS's plan, also to make the change to our new insurance that much easier. So, does your advice still stand?? LOL!!

DH checked the COBRA rate with Mayo and it is $1380 for one month. With the Short-Term Choice, my deductible would be $1000. So, either way, if something were to happen, we'd be paying the $1000.

Wow, this is just great news! Thanks so much for your reply, you probably just saved me $385!! I'll have to send you a gift certificate or something!!

Thanks again!

Krista

 

[manchurianbrownbear]

I'm sure you'll be very happy with Medica!

Are you aware that Mayo isn't in our network !


Let me know if you ever have any questions.