Health Insurance Question

[hold48398]

Our whole family is covered through my husband's health insurance policy at his work. He has been there for almost 5 years now and he was working there when Mia was diagnosed with D 2 years ago. We are lucky to have pretty good health insurance through this job.

What would happen if he no longer worked there or decided to take another job? Would Mia be able to get coverage at another job he takes or would she be labeled preexisting condition and become uneligible??

Pretty scary thought. Just crossed my mind. Tell me it wouldnt be so, please.

[Barry]

I'm not an expert on the subject but the one thing that makes a difference is her not having a "lapse" in insurance. HIPPA....(forgot what it stands for) requires employers of a certain size to "honor" her condition as long as she was insured with some other insurance at the time she became eligible for the new insurance and you chose for her to have the new insurance during the "open enrollment period" at the new employer. Sometimes this means electing the COBRA (an extension of the old insurance) option from the previous insurer at your cost for several months. W/out this "non-lapse", some compinies will exclude the condition for "x" number of months, usually 12

[dmconrad]

Barry is right. I read the Health Insurance Portability and Protection Act (I think that is what HIPPA stands for) several years ago for another reason. What I remember is that as long as you are going from one group coverage to another without a lapse in insurance the new insurance company has to pick you up and you are not subject to pre-existing conditions clause as long as there has been no lapse and your pick up the insurance as soon as it is offered to you. So you have to elect COBRA coverage from your current insurance for any lapse in time to when you start the new job or when the new insurance kicks in.

THat is all true for Group coverage (and as Barry said, there is a size parameter). In addition, the company that covers the group at your new job can not refuse your family (assuming you meet the guidelines outlined above) or refuse a member of your family or require your family to pay a higher premium. However the insurer can raise the rates of everyone in the group if they so choose and can choose (based on the terms of the contract with the employer) to stop insuring that group, but can not exclude an individual or family.

THat is why it can be hard to be self-insured or work for a smaller company that employes a smaller number of people. They don't have the same "buying" power as a larger company. This is why I go to work every day and will never willingly leave my job! My husband is self employed and while he has a group policy for his employees, we are not a part of it. If we were all of their rates would go through the roof and they would not be able to afford it. I work for a very large organization and they don't even notice us!

Here's hoping this NEVER happens to anyone!!

[MrsBadshoe]

We were fortunate that when my DH lost his job 2 yrs ago my one D child was on State medicaid...In PA and a few other states they have a cronic ill portion of the health care insurance that provides insurnace to children under 18 as primary or secondary insurance. Now that my dh is employed again state medicaid is used as secondary and pays all of our co pays.

[hold48398]

Thank you very much for your answers!!!!!

[Momof4gr8kids]

Here is what I have learned from moving from a fairly sheltered state to one of the worst states as far as health insurance goes.
I lived in Utah my whole life up until July of 2005. After we got settled I started looking at health insurance. Because Utah was set up so different as far as HMO's went what I expected was to call an agent, and they would give me a quote for me, DH, and in Utah you just pay for children weather you have 1, or 6 it is the same price, they don't ask about pre existing, the only problem is doctors visits, and hospital issues that pertain to a preexisting condition will not be covered for 12 months unless you have been covered with in 90 days, and they will deduct the months from how long you have already carried insurance. So that was what I expected in Idaho. I had never known anything different. DH was disqualified in Idaho, except for a cronic condition type of insurance that was like give us all of your money for -well I wont spell it all out, but him alone through this was more then me + 4 kids, and that was more then I had paid for insurance for the whole family in Utah. I was working part time at the time, and Shane, until next week is self employed so we started looking further into state laws, which in Dec of 2005 we found out that if I could get insurance through a job they could not disqualify Shane, or charge an arm, and leg, just not cover the D. So we decided at the end of Jan I would switch jobs. I put in my two weeks, and trained my replacement, since I was working a late shift I decided to look for a job the next week, however Julia was dx'd with D the Sat before I was to start interviewing. At the time I didn't know the 504 laws were for daycare, too. So I canceled all of my interviews. I started searching for a way to get Julia insured. I added up sums, and found out that our kids could be covered by Chip B. Which is a lesser form of medicaid. So I filled out the app, I found out that since I have a child who has an IEP for ADHD, and now I had a child with a cronic illness plus Shane was self employed we were able to get medicaid. I never thought I would actually be thrilled to qualify for medicaid. However I was. It was backdated to Jan when we finially got it, and covered some of the costs incured from diagnosis. Some of our docs weren't on the list, and we went over our CDE hours, but we made it!

My best advise is to look at state laws, and before moving look at the laws for that state as far as insurance goes. Also check out if there are any special programs in your area for kids with disabilities run through the state. There is tons of help out there if you find yourself in this same spot. Our diabetes team was great at helping me to stock pile the first few months before we were covered. We did have to still buy alot, but wouldn't have made it without them. People do care, people who know D know how expensive it is if you have to do it on your own, and are always willing to give "samples" and discounts.

It is a huge worry, but IF it ever does happen you will be ok, and make it through it all.

[hold48398]

Thank you for sharing your experience, Jamie...it's much appreciated and good advice!!!

[Momof4gr8kids]

You're welcome! I hope with all of the posts your mind is eased some.

[allisa]

Unfortunaltely....my ex is kinda jumpy on the careers......He's had 5 differnt jobs (and 5 differnt inusrances since dx).....thankfully all has turned out fine....doctors accept all.....and insurance accepts all of us ......I think the "lapse" in insurance coveraage is the worrisome part....NEVER want to have a lapse...

[BrendaK]

I used to work in benefits several years ago -- according to HIPPA, your lapse of coverage cannot be more than 63 days. Actually, I knew this from my job, but also from personal experience. My husband took a new job about 1 1/2 years ago and the coverage didn't start for 62 days after we lost coverage from his old job. Since you have 60 days to elect Cobra, which was very expensive, we decided not to elect cobra unless something happened in that 60 days that we needed coverage -- we took our chances for the 2 days after the 60 days.

And since our coverage was within 63 days of our last coverage, we were added on the new insurance without any preexisting conditions.

This 63 day rule, I believe may only apply to Group insurance through a company. Don't quote me, but I don't think that the same rules apply to individual policies. We have also had a TON of problems in the past trying to get individual coverage. The laws on that are really screwy in Michigan. My husband got denied individual coverage because he he hurt his back once at work and had to go to the doctor and was fine after taking some advil -- but coverage was denied because of that. My friend's husband got denied in Michigan because he had a wart on his finger once. Michigan has a law that says that insurance companies have to waive preexisting conditions after a year of coverage. So, now all of the insurance companies are just denying everyone any individual coverage because they don't want to have to cover them for everything after that year of coverage. Individual coverage is basically impossible in Michigan!!

My husband once had dreams of starting his own business, but has decided not to pursue it -- a part of that decision was because of how hard it is to get individual coverage here in Michigan.