Pre-Existing Insurance question

[JoiseyMom]

Ok, DH has been out of work since July. Insurance ended July. We have not done COBRA...it is way too costly. Now, there is a potential job, but benefits won't kick in until Nov. So that is 3 months without insurance. Now kids and DH have pre-existing conditions.

With new Obama care does that matter anymore?? My head is spinning with so much stuff going on with the flood damage, repairs, job hunting, school starting that I can't think.

Does anyone have any experience with this??

Thanks guys!

 

[dis-happy]

I only know the old rules, which is you don't want to go w/o insurance for more than 63 days. It might not be too late to sign up for COBRA, and it might be totally worth it until you kick in with new insurance. Or at least get a high deductible personal/individual policy. Too scary to let insurance completely lapse, even if young and healthy---I was dx with cancer at age 27 (and thankfully had insurance).

 

[JoiseyMom]

I only know the old rules, which is you don't want to go w/o insurance for more than 63 days. It might not be too late to sign up for COBRA, and it might be totally worth it until you kick in with new insurance. Or at least get a high deductible personal/individual policy. Too scary to let insurance completely lapse, even if young and healthy---I was dx with cancer at age 27 (and thankfully had insurance).

I used to think that way too.... but we can't afford 1600.00/month for 3 months.

 

[bkaz]

I agree with pp...we too did not want to pay the high price of COBRA, but were able to get a policy through an independent broker that was high deductible and more reasonable in price. Don't know what the pre existing conditions are, but it would be worth it to me to have continuation of coverage.

 

[stm61]

If your husband is unemployed will the kids qualify for Medicaid? It's based on family size and income. Your husband might also qualify for benefits if he has a long term condition. I used it when both my husband and I were unemployed. It covered all my kids medical needs, but SC has no program for adults unless they're disabled or chronically ill. A month after we qualifed I went back to work. I called the DSS caseworker, who thanked me for letting her know, but she said once qualified the kids keep coverage for a full year. I didn't have to put them on my policy at my new job, which saved me a nice amount, until their medicaid ran out. At that time I added the kids to my policy with no problem.

 

[JoiseyMom]

If your husband is unemployed will the kids qualify for Medicaid? It's based on family size and income. Your husband might also qualify for benefits if he has a long term condition. I used it when both my husband and I were unemployed. It covered all my kids medical needs, but SC has no program for adults unless they're disabled or chronically ill. A month after we qualifed I went back to work. I called the DSS caseworker, who thanked me for letting her know, but she said once qualified the kids keep coverage for a full year. I didn't have to put them on my policy at my new job, which saved me a nice amount, until their medicaid ran out. At that time I added the kids to my policy with no problem.

I applied for the NJ kids health care in NJ. The web site says you have to be without insurance for 3 months...they are processing us, so I have no idea if we will get it or not. He also has severance that runs out in 2 weeks, so we technically have income, even if it is just temporary.

 

[BubMunkeyBles]

I only know the old rules, which is you don't want to go w/o insurance for more than 63 days. It might not be too late to sign up for COBRA, and it might be totally worth it until you kick in with new insurance. Or at least get a high deductible personal/individual policy. Too scary to let insurance completely lapse, even if young and healthy---I was dx with cancer at age 27 (and thankfully had insurance).

Yep, I agree. I can't imagine going without completely (I was dx with cancer young too though and chemo alone costed $30,000/day). My friend had high deductible insurance which mostly covered catastrophic type stuff.

 

[disneymamato2]

I work at a major insurance company and I might be able to answer your question. With the new health care reform pre existing does not apply to anyone 19 and under, if the plan is grandfathered then it may apply so double check with the insurance company. For you and your husband they should be going off the hire date not the date you get the insurance. If the time between when he lost his job in July and when he is hired with his new job is less that 63 days you should be fine, as long as you have enough creditable coverage from your other policy. Most plans are 12 month for timely enrollee and 18 months for late, but again you would need to check with the insurance company. The hr department at the company should be able to help you or the insurance company maybe able to also.
If you do go over the 63 days the insurance will then establish if that was the first date of treatment for the condition you went to the provider for. (There is usually something that will flag their system based off the diagnois the provider bills on the claim.) They will ask for information from your provider t, also most plans have a look back period. Say you went to the doctor for back pain and the claim pends for pre ex and the provider said you were seen for back pain 12 months ago, if the plan has a 6 month look back that claim would not be pre ex. Also not all plans have a pre existing condition clause on there policies. If you know you are going to be going over the 63 days I would look into getting a short term policy. Most are inexpensive and they are fairly easy to get. Hope that helps.

 

[TheRustyScupper]

From the point of view of a CEO who bought group insurance:

1) Check the name of the new insurance company.
2) MOST group policies DO NOT have pre-existing illness clauses.
3) MOST states DO NOT allow group policies to exclude pre-existing.
4) I do not know your new company or the insurance company.
5) But, after buying a lot of coverages, my bet is that you will be OK.

NOTE: I AM NOT A INSURANCE EMPLOYEE OR STATE INSURANCE
BOARD MEMBER. SO, THIS IS NOT A GUARANTEE. IT IS ONLY AN
ASSUMPTION FROM MY PREVIOUS EXPERIENCES. CHECK WITH THE
NEW INSURANCE COMPANY.

 

[mrsklamc]

I used to think that way too.... but we can't afford 1600.00/month for 3 months.

If you think you can't afford that then you DEFINITLY can't afford to be without coverage- and since you know your DH has a new job it's even worth taking on $1600 worth of debt for 3 months. Young cancer patient here too- my surgery pre insurance was 40k for less than one day in the hospital.

 

[Cindyrellablue]

In NJ, you cannot be denied coverage for any pre-existing medical condition if you purchase insurance on your own and have a lapse in coverage. I am ignorant on the Obamacare thing, but as an adult with asthma and other previous issues,the laws in this state won't allow denial.

Hope it stays that way here

 

[Muushka]

I have a feeling that Obamacare will more than likely be repealed.

I hope everything works out for you. It is a difficult position to be in.

 

[intheworks]

I used to think that way too.... but we can't afford 1600.00/month for 3 months.

You wouldn't have to pick the COBRA up for 3 months;just a month or so or enough time to get you under that 63 day clause, if there is one.

 

[angierae]

From the point of view of a CEO who bought group insurance:

1) Check the name of the new insurance company.
2) MOST group policies DO NOT have pre-existing illness clauses.
3) MOST states DO NOT allow group policies to exclude pre-existing.
4) I do not know your new company or the insurance company.
5) But, after buying a lot of coverages, my bet is that you will be OK.

NOTE: I AM NOT A INSURANCE EMPLOYEE OR STATE INSURANCE
BOARD MEMBER. SO, THIS IS NOT A GUARANTEE. IT IS ONLY AN
ASSUMPTION FROM MY PREVIOUS EXPERIENCES. CHECK WITH THE
NEW INSURANCE COMPANY.

This is what I was going to say. I have Blue Cross/Blue Shield of Michigan, and when you have a group policy like through an employer, they do not have any sort of pre-existing illness clause.

If your new insurance DOES, however, I would pick up a month of private high-deductible insurance before you hit the 63 day mark just to cover your butt.

 

[dhardawa]

If it is a group plan, it is highly, highly, highly unlikely that there will be any pre-existing conditions. The whole idea of a group plan is that the health is looked at as a whole and priced as such.

 

[3boymthr]

Here are your rights under the laws:

http://www.dol.gov/ebsa/newsroom/fshipaa.html

Get a certificate of creditable coverage and have it applied to your new policy. Even though you are past the 63 day window you should still get come credit toward pre-x clauses.

On another note, are you past the election time limits on COBRA election? (since he's only been unemployed since July probably not) Did you decline it? Did you know that under the law you can elect COBRA just for your DH?

If you are still within the window to elect, then add up your costs for medical coverage since July - how does that compare for DH for a single (instead of family) policy? Elect just the single policy - pay for that and then you can submit for the bills you had for DH to offset the cost of the policy.

 

[drinkme]

From the point of view of a CEO who bought group insurance:

1) Check the name of the new insurance company.
2) MOST group policies DO NOT have pre-existing illness clauses.
3) MOST states DO NOT allow group policies to exclude pre-existing.
4) I do not know your new company or the insurance company.
5) But, after buying a lot of coverages, my bet is that you will be OK.

NOTE: I AM NOT A INSURANCE EMPLOYEE OR STATE INSURANCE
BOARD MEMBER. SO, THIS IS NOT A GUARANTEE. IT IS ONLY AN
ASSUMPTION FROM MY PREVIOUS EXPERIENCES. CHECK WITH THE
NEW INSURANCE COMPANY.

I agree with this. Our experience for our family is that group policies do not have the pre-existing clause with it. When our dd12 was born with a congenital heart defect, the cardiologist told my husband that he could never quit his job because we wouldn't get health insurance for her anywhere else to cover her heart. So, once that clause was "lifted" from our state (or was it national????) about 7 years ago, then my dh was able to change jobs.

It is my understanding that as long as it is a group policy it is ok. Individual policies still can put on restrictions. I don't think Obama's health care plan for preexisting conditions has kicked in yet. But I could be wrong.

BTW, our insurance is Blue Cross/Blue Shield.

HTH

 

[dis-happy]

Ok, DH has been out of work since July. Insurance ended July. We have not done COBRA...it is way too costly. Now, there is a potential job, but benefits won't kick in until Nov. So that is 3 months without insurance. Now kids and DH have pre-existing conditions.

With new Obama care does that matter anymore?? My head is spinning with so much stuff going on with the flood damage, repairs, job hunting, school starting that I can't think.

Does anyone have any experience with this??

Thanks guys!

My concern is this is only a potential job....if he doesn't get it, you are still without insurance and past the 63 days. Many small companies don't even offer full coverage group insurance. Really, in your shoes, I would be doing everything possible to at least get a lower cost/higher deductible coverage plan for your family asap.

 

[DisneyNutMic]

Yes pre-existing conditions still exist.

My brother was in the middle of a divorce. His insurance was through his estranged wife who was a member of the National Guard. He had been diagnosed with leukemia and treated showing a clean bill of health for 3 years. He knew his insurance was to be terminated after the divorce and had insurance set up to start on Sept 1st. Was about to have neck surgery before his insurance through his wife was terminated and they did a blood test just to make sure his leukemia was GONE. On August 10th their divorce was final and instead of the insurance being effective until Aug 31st (and being offered Cobra) the insurance was terminated immediately without his knowledge. On Aug 15th his bone marrow biopsy came back showing 1% of his cells showing leukemia again. He paid the premium that he was quoted for Cobra. He was admitted to the hospital on Aug 22nd to begin treatments and the hospital came to him and said that his insurance was terminated. And since his now ex wife wasn't active duty, Cobra wasn't available to him. He is now fighting cancer with NO INSURANCE and no one will cover him because of a pre-existing condition.

 

[caborst]

There is a program called NJ Protect that provides coverage for adults with preexisting conditions. The premiums ran ~ $300/month. You have to be without coverage for 6 months with an existing medical condition to qualify.

Because the program is federally subsidized, treatment for pre-existing medical conditions will be covered as of the day a policy goes into effect, and preventive care will be covered at no out-of-pocket cost to the policyholder. This is quoted from the website.
http://www.state.nj.us/dobi/division_insurance/njprotect/index.htm

Detailed information is on the website. I know this does not help the OP but it may help someone else. This program is NJ specific but all states should have something similar as it was part of the insurance reform.

OP-I would call about the 3mo. waiver of no insurance for the children. When coverage is lost due to unemployment, the time is usually waived.