Healthcare question?

[auntie]

Okay..not a debate. Only a question. Maybe there are a few other's facing this situation.
I've got a daughter who is gonna be 23 next month. At which point..she would have been off our Empire BC/BS coverage.
She has a job..it offers health care. Not the best..and it's not cheap. Consideriing what she's making. It's taking a LOT of out of her salary. Only..what choice do we have..she had to go with it. Yet..she'd like to continue with school to get her Bachelors in Early Childhood Education. (she got her Associates last year)
Now..it turns out as of April 1st, we're switching to a new Health care plan. A GHI/EMBLEM. I don't know how good or bad it is..but it was cheaper than the Empire we were with, and we had no choice but to make the change.
Because Empire didn't cover my daughter past age 23..I didn't even put her on the GHI application.
That might have been a mistake..today, I get the book regarding coverage from GHI..that says they cover dependent kids to age 25. They have to be students..but it doesn't say they have to be "full time" students. Just that you have to provide 50 % of their support.
I plan to call them Monday, and see if I can add her. Of course it also had a clause about the child having been on the policy at the time of initial coverage. Uh..oh. I've got to move on this. I'm wondering if she goes part time to school and lives at home if they will cover her?..

AND..how does the new health care reform bill effect all of this?


I've looked this up everywhere..but can't get a straight answer. I've read that according to the new bill.. your carrier is supposed to cover dependent kids living at home to age 26...but I can't seem to get answer as to whether they have to be students..full time students, part time students...or what have you.

Anyone else out there with kids who were going to be off their health coverage..and what did you do?...It's my understanding that this part of the bill was supposed to be immediate..not phased in four years, like other aspects.
Appreciate the help guys.

Oh..and I've got a call into the broker..but I doubt I'll hear from him before Monday. When I spoke to him yesterday..he knew less than I did. He's gonna get back to me.

 

[LarryJ]

Okay..not a debate. Only a question. Maybe there are a few other's facing this situation.
I've got a daughter who is gonna be 23 next month. At which point..she would have been off our Empire BC/BS coverage.
She has a job..it offers health care. Not the best..and it's not cheap. Consideriing what she's making. It's taking a LOT of out of her salary. Only..what choice do we have..she had to go with it. Yet..she'd like to continue with school to get her Bachelors in Early Childhood Education. (she got her Associates last year)
Now..it turns out as of April 1st, we're switching to a new Health care plan. A GHI/EMBLEM. I don't know how good or bad it is..but it was cheaper than the Empire we were with, and we had no choice but to make the change.
Because Empire didn't cover my daughter past age 23..I didn't even put her on the GHI application.
That might have been a mistake..today, I get the book regarding coverage from GHI..that says they cover dependent kids to age 25. They have to be students..but it doesn't say they have to be "full time" students. Just that you have to provide 50 % of their support.
I plan to call them Monday, and see if I can add her. Of course it also had a clause about the child having been on the policy at the time of initial coverage. Uh..oh. I've got to move on this. I'm wondering if she goes part time to school and lives at home if they will cover her?..

AND..how does the new health care reform bill effect all of this?


I've looked this up everywhere..but can't get a straight answer. I've read that according to the new bill.. your carrier is supposed to cover dependent kids living at home to age 26...but I can't seem to get answer as to whether they have to be students..full time students, part time students...or what have you.

Anyone else out there with kids who were going to be off their health coverage..and what did you do?...It's my understanding that this part of the bill was supposed to be immediate..not phased in four years, like other aspects.
Appreciate the help guys.

Oh..and I've got a call into the broker..but I doubt I'll hear from him before Monday. When I spoke to him yesterday..he knew less than I did. He's gonna get back to me.

For the current rules it's best to check with your health care provider and see what they say. For the new "HEALTH CARE" bill most don't know, but the bill is just a set of goals and framework that has to be implemented with regulations, etc. and then the big if funded separately. Thus I would not look for any changes in the status quo for the details in the next few months to a year.

The ole saying the devil is in the details and this new HEALTH CARE bill has very, very few implementation details in it.

Larry

 

[auntie]

Provider told the broker..they are sending out new literature with updated information within the next month. I realize most of the bill is being phased in..with a few exceptions that were supposed to be immediate..and this was supposed to be one of those. Seems one hand doesn't know what the other is doing though.

 

[mnsprk]

Seems one hand doesn't know what the other is doing though.

Nothing new for Insurance Companies and especially the Government!

 

[disney4dan]

Watching this closely as well. Justin turned 18 this past week and the last time I checked into this he would be covered to 19 before they seek proof that he is still a full time student. BUT, there were some issues this past winter where we had to battle the carrier on a DAILY basis and still do not have it all straightened out. The kids first cancer surgery goes 12 hrs with enough professionals in the room to field a baseball team and everything got covered without a peep. But try to get the kid some help to recover from the damage done by the Rx pain meds and you would not believe the hassle. Sure, I don't see any problem driving 250 miles each way to find an in-network provider. And then, every time we called to ask about coverage we would get a different answer. I finally vented to one of the supervisors one night when they called back on a Friday at 6:00pm to say they were not going to cover the costs. Somewhere there is a recording of me unloading on that poor woman, but the attitude she copped with me once she learned what type of treatment it was just set me off. It's just that we frequently get little to no straight answers from the company and they can always turn around and say the first person we spoke with was wrong, sorry, you'll have to pay for that yourself now.

Good luck Phyllis, these are not the same issues our parents had to deal with.

 

[ftwildernessguy]

As someone who deals with health insurance companies on a daily basis, I feel your pain. To top off the inherent problems with insurance companies, they pay incentives to their reps to save money by changing codes and rejecting claims. By postponing payment on claims for one day, an insurance company can make a million dollars on their investments. Personally, I don't feel health insurance companies should be allowed to invest for profit, since it seems to be at the expense of the individuals insured.

As far as the "health reform bill," it is over 2700 pages long and I doubt Larry or anybody else has read it. I saw on a morning news program an interview with a college professor who has written a book about health reform in America. He stated he has read the bill and doesn't understand it. It is chock full of pork that has little or nothing to do with health reform. From what I have seen, it seeks to control costs by cutting payments to hospitals and doctors, but does nothing to control their expenses and overhead costs. In fact, by taxing medical equipment, the government will actually increase the cost of providing care but cut the reimbursement for the same. Mandating coverage is a whole other ball game. It will open the flood gate for junk policies to provide minimum coverage that will meet government requirements but provide no benefits. Think about companies that provide minimum state coverage for auto insurance and apply that to your health care. Insurance companies will reap huge profits and only have to provide a cheap plastic card so you can prove to the government you have insurance. There is no doubt the health care industry needs a fix, but at the risk of sounding political, I don't believe the fine folks that administer the social security system and the IRS are capable of making these changes effectively, especially when the insurance companies have so many of our lawmakers on the payroll.

 

[RvUsa]

Jim Very well put! I am chastised all the time that I am anti health care reform, and I don't care about the uninsured etc. I am VERY pro heath care reform, what I am is anti govt controlled heath care. Take out the pork and BS in this bill and you might have the start of something worthwhile, but right now it is just bad bad bad.


Phyllis, good luck figuring it out, I deal with my insurance problems on a daily basis, and can never get a straight answer 2 times in a row!

 

[Millermouseketeers]

The part for keeping our kids on our insurance until 26 will take place in 6 months. My sister just had to deal with this and this is what she found out.

 

[auntie]

I shot an E-mail to a local representative..no reply. He probably doesn't understand it either.
Is it me or what?.. It just seems to me that all the hoopla this week and the media is singing the praises of this thing telling us it's great, but you can't actually pin down where it applies specifically to you?... I mean, Okay..so I'm no genius (okay..no cracks..I know you're all rolling your eyes with that one) only shouldn't someone be able to tell you how it specifcally applies to the everyday person. Seems to me it doesn't.
The broker is useless.., I mean I had to tell HIM..there was a bill signed into law last week....and the insurance company gives you the run around, with "we will update the information, you should receive it in a month". Another way of saying.."we don't have a clue either".

I'm gonna stay on top of this..but I think it's a simple question. If the insurance companies are supposed to extend coverage to age 26, does the kid have to be a full time student, part time student, no student, work pt. time full time...or what?..
It would be nice to have her still on our policy and give her more options as to whether she can get back to school..or whether to cut her hours at work to part time, so she can go back. Only we don't dare do anything at this point.
Our new policy starts next week, and their coverage says they cover till 25 if a student. Only..again..no where does it say... Full, part time..waiting to hear back on that too. I tell ya..it's like bangin' your head on a wall.

 

[ftwildernessguy]

, and can never get a straight answer 2 times in a row!

My wife actually has to deal with the insurance companies more than I do, and I tell her if she is not getting the answer she needs or feels is correct, hang up and call again. You almost never get the same story twice.

 

[LarryJ]

I shot an E-mail to a local representative..no reply. He probably doesn't understand it either.
Is it me or what?.. It just seems to me that all the hoopla this week and the media is singing the praises of this thing telling us it's great, but you can't actually pin down where it applies specifically to you?... I mean, Okay..so I'm no genius (okay..no cracks..I know you're all rolling your eyes with that one) only shouldn't someone be able to tell you how it specifcally applies to the everyday person. Seems to me it doesn't.
The broker is useless.., I mean I had to tell HIM..there was a bill signed into law last week....and the insurance company gives you the run around, with "we will update the information, you should receive it in a month". Another way of saying.."we don't have a clue either".

I'm gonna stay on top of this..but I think it's a simple question. If the insurance companies are supposed to extend coverage to age 26, does the kid have to be a full time student, part time student, no student, work pt. time full time...or what?..
It would be nice to have her still on our policy and give her more options as to whether she can get back to school..or whether to cut her hours at work to part time, so she can go back. Only we don't dare do anything at this point.
Our new policy starts next week, and their coverage says they cover till 25 if a student. Only..again..no where does it say... Full, part time..waiting to hear back on that too. I tell ya..it's like bangin' your head on a wall.

I think you are now finding out what I posted in my prior post that the bill was the framework and the details to be done by executive order a regulatory body not yet appointed or the regulations written is why like who is under 26 it will cover doesn't exist at that level of detail.

I think the 6 months for this to be implemented is for this procedure is a goal to be worked out if possible.

I'm just glad that this mess doesn't effect us, or sons or their families and couldn't imagine what I'd do if I had to operate under this new Health Care Bill.

Larry

 

[kc5grw]

I think you are now finding out what I posted in my prior post that the bill was the framework and the details to be done by executive order a regulatory body not yet appointed or the regulations written is why like who is under 26 it will cover doesn't exist at that level of detail.

I think the 6 months for this to be implemented is for this procedure is a goal to be worked out if possible.

I'm just glad that this mess doesn't effect us, or sons or their families and couldn't imagine what I'd do if I had to operate under this new Health Care Bill.

Larry

Actually, companies are already being forced to make changes due to requirements in the bill for immediate implementation of certain provisions. See the story here: http://www.businessinsurance.com/article/20100326/NEWS/100329940

 

[ftwildernessguy]

I think you are now finding out what I posted in my prior post that the bill was the framework and the details to be done by executive order a regulatory body not yet appointed or the regulations written is why like who is under 26 it will cover doesn't exist at that level of detail.

I think the 6 months for this to be implemented is for this procedure is a goal to be worked out if possible.


Larry

 

[LarryJ]

Actually, companies are already being forced to make changes due to requirements in the bill for immediate implementation of certain provisions. See the story here: http://www.businessinsurance.com/article/20100326/NEWS/100329940

What I'm talking about is what is in the actual bill. Now this is the Senate's version they passed as best as I can tell Text of the Amendments of the Senate to HR 3590 (Senate Health Care bill) on pages 22 on you will see what I've been referring to. This is probably not the actual bill, but shows the structure of what has been passed. These 2400+ pages plus reconciliation amendment/bill and managers amendment come close to the 2700 pages often cited as the length. The above link came from the first three links HERE called "Bill Text" which as best as I can tell is the actual bill that was passed and sent to the president.

Larry

 

[CaptDadSparrow]

Passion runs deep on both sides of the issue. But the facts of the bill state, dependents may continue receiving benefits under your current plan through age 25.

Everything else said is simply partisan passion. Change IS always challenging and the devil is always in the details...sorta.

Just keep claiming them under your plan until you are told you can't.

Kind Regards,

 

[auntie]

Passion, partisan, ...I don't care about any of that. It is, what it is. Only...WHAT IS IT? ... Just want a STRAIGHT answer. No one I speak to is really clear on it. I do find it strange that the media is all over this landmark legislation..but no one really knows what it is.
To just say, keep them on your policy till they say you can't. Well, ....I did that. They said..they "you can't" past 23. She'll be 23 next month. So, we had her take full time hours so she'd qualify for health benefits through her employer. This meant ..she couldn't continue school for her Bachelors.

New healthcare provider literature I received on Fri. says they cover till age 25...only she had to be on the policy when we got it. Ooops...I didn't apply with her on the policy, because I didn't realize they would have accepted her.
So..my first course of action will be to see if I can add her to my new coverage that starts April 1st. Let's hope the ship didn't sail on that. Only...even with them..they aren't clear on whether she has to be a full time student to have coverage.
Am I suppose to just lie and say she is?...Then what if that comes and kicks me in the butt.
For right now..she's staying with her full time hours and coverage with her job. I'lm waiting to see if the opportunity exsists for her to swtich back to our coverage, which would give her the opportunity to finish up her education. Time wise..the 25 or 26 would be great.
Of course then we're paying for college again (that's another thread)

 

[AuburnJen92]

Jim Very well put! I am chastised all the time that I am anti health care reform, and I don't care about the uninsured etc. I am VERY pro heath care reform, what I am is anti govt controlled heath care. Take out the pork and BS in this bill and you might have the start of something worthwhile, but right now it is just bad bad bad.


Phyllis, good luck figuring it out, I deal with my insurance problems on a daily basis, and can never get a straight answer 2 times in a row!

I understand you are chastised. If your other friends are like that Matthew you have on FB, I sincerely feel sorry for your pain.

 

[2goofycampers]

I understand you are chastised. If your other friends are like that Matthew you have on FB, I sincerely feel sorry for your pain.

He sounds more like a relative, outlaw maybe.

 

[LarryJ]

Passion, partisan, ...I don't care about any of that. It is, what it is. Only...WHAT IS IT? ... Just want a STRAIGHT answer. No one I speak to is really clear on it. I do find it strange that the media is all over this landmark legislation..but no one really knows what it is.
To just say, keep them on your policy till they say you can't. Well, ....I did that. They said..they "you can't" past 23. She'll be 23 next month. So, we had her take full time hours so she'd qualify for health benefits through her employer. This meant ..she couldn't continue school for her Bachelors.

New healthcare provider literature I received on Fri. says they cover till age 25...only she had to be on the policy when we got it. Ooops...I didn't apply with her on the policy, because I didn't realize they would have accepted her.
So..my first course of action will be to see if I can add her to my new coverage that starts April 1st. Let's hope the ship didn't sail on that. Only...even with them..they aren't clear on whether she has to be a full time student to have coverage.
Am I suppose to just lie and say she is?...Then what if that comes and kicks me in the butt.
For right now..she's staying with her full time hours and coverage with her job. I'lm waiting to see if the opportunity exsists for her to swtich back to our coverage, which would give her the opportunity to finish up her education. Time wise..the 25 or 26 would be great.
Of course then we're paying for college again (that's another thread)

Here is how I read your above quoted post and your original post as being the facts of this case and this is just my personal opinion on what I see as the facts.

1. You daughter is not now a full time student since you said in the above post she had to go full time at here job to get health care and couldn't continue persuing her bachelor's degree. I'm not sure you can unring this already ringing bell.

2. She is or should not be your dependent since she has a full time job and can even buy health care and while I don't know I would think this extension of carrying a child on their parents policy is for dependents that are still in school or living at home and being claimed as a dependent on their parents income tax.

Just be careful since as I see it with the increased costs to insurance companies they just might go after even minor insurance fraud cases much harder than in the past.

I ran into something similiar where I had to jump thru hoops to carry our sons as a dependent with military I.D. cards, medical and dental coverage under my name when they were full time students and got to 21 and the military coverage was till 23 at that time and only if on certification by the college they were a full time student carrying what the college classified as a "full time" course load ... i.e. part time or night didn't fit the requirements. Just wait till the military complain because current rules are now 23 for them and if the new bill says 25 or 26 now the DOD has to change what they do and their policies and that is a completely different branch and rules than what the HHS controls ... WATCH OUT. This is the lack of details and the devil I have mentioned that is in the weeds that is going to cause HUGE issues in implementing this ill conceived and poorly drafted law all in the name of being able to say WE DID SOMETHING.

Sorry for the negative outlook, but I think the links I have already provided give folks a good look into the holes in this new bill.

Larry

 

[clkelley]

Totally unrelated to the Bill, but what we ended up doing for our older son when he stopped being a full time student, and couldn't get health care from his burger flipping job is purchased cheap catastrophic care health insurance. It has lousy coverage, BUT, he will have a piece of paper that states he has "continuous coverage". That way, when he does get a real job, or gets back to school full time before age 25, there is no waiting period on preexisting on any coverage he may get. He is a healthy kid with just the occassional bug or strep throat, so we just pay the doctor and the prescriptions on those rare occasions. But, if something disastrous does come up, or he is in a serious accident, our total out of pocket per year is $5,000. So far, it has worked well and has been very cost effective, considering that Cobra was going to be $400 per month just for him. His monthly premiums are $45 per month, and he's been to the doctor once since then for a total cost of $250 with strep screen and antibiotics.