HIPAA/child with pre-existing condition

[tinker&belle]

Hi everyone...
I am looking for people's past experiences since I cannot get a clear answer so far. I have talked to ASK, the Dept of Labor and my DD's OT from First Steps (our state's service for children 0-3).

We have private health insurance. It is expensive, but it is pretty good coverage. My DH has been offered a job he wants to take from another company that also offers coverage.

My understanding of HIPAA is there can be a 12 month pre-existing condition exclusion (or 18 months if you don't join when you are employed immediately.) If you have had coverage for a time period prior to the new coverage the prior coverage counts toward the time needed for pre-existing exclusion.

We have been covered as a family for the past 12 months. However, DD is only 6 months old. We enrolled her as soon as we could after birth (within the 30 needed for the other aspect of HIPAA).

Has anyone else ever been in this situation? I know insurance coverages vary, so I know if someone else had it covered it doesn't guarentee we will be, but I feel like we are in a unique situation and am looking for help from anyone else who has been here.

Dept. of Labor can't even help. The lady I talked to told me we "have a good argument." We need her to be covered, a gap is not an option.

If she is not coverable, we will have to maintain COBRA until she is 1, which would be over 1000 a month, plus any expenses (and she may have tubes put in her ears in a month)would not apply toward new deductible.

Thanks for any help or insight!

 

[ireland_nicole]

I don't know if each state is different, but when we had to make several insurance changes here in TX, they had to cover everyone under the company's group policy as long as we had had coverage prior. If we had not paid the kids premiums through the start date of the new insurance, there would have been a waiting period, but because we did have uninterrupted coverage, they had to continue it w/o the preexisting clause. Not sure if it helps, but that was our experience. This was in late 2006.

 

[jmartinez1895]

Your current insurance company will provided you with a certificate of certified coveradge ( they may call it something else, but it should be something like that). It will tell your new insurance company that the child has been covered and is insurable.

 

[disfan07]

My dad just got a new job 1 1/2 years ago. I have multiple pre-existing conditions and I was covered automatically by the new health insurance when we switched.

 

[MandM-Mom]

Here in ny I think you can't lapse for more than 63 days or preexisting won't be covered.

 

[tinker&belle]

Thanks for the replys everyone. I had meant to post an update. He got the job and I spoke with the lady in the HR department. She gave me the insurance company name and group number and she said that there were no pre-existing exclusions on the policy.

There IS a waiting period of 30 calendar days to start the policy. I called the insurance company and they would not verify if there was a pre-existing condition exclusion since I didn't have a policy number yet, but they did say that even though she had less than a year of coverage, she was considered part of our year of 'family unit' coverage. So we should be safe either way.

So right now we are holding our breath until the last week of February. If we have a major medical issue we will elect COBRA (it is retro-active), but as of right now we have only been to the doctor for a flu shot for younger DD and have her apnea monitor rental. It would be really nice to just pay these OOP and have the money we would need to put for COBRA toward the deductible and OOP MAX for the year. 19 days to go!